When to See a Fertility Specialist: Signs, Costs, and What to Expect
Deciding when to seek help from a fertility specialist can feel overwhelming. You may wonder if you're jumping the gun or waiting too long. The truth is, there are clear guidelines about when to seek help, and getting an evaluation sooner rather than later can provide valuable information -- even if everything turns out to be fine.
This comprehensive guide covers when to consider seeing a fertility specialist, what to expect at your first appointment, common tests and treatments, how irregular periods factor in, insurance coverage, male factor infertility, emotional support resources, and questions you should ask. Whether you have been trying for months or are just starting to think about your fertility, this article will help you make informed decisions.
General Guidelines
- Under 35: See a specialist after 12 months of trying
- 35-39: See a specialist after 6 months of trying
- 40+: Consider seeing a specialist before trying or immediately
- Known issues: See a specialist right away if you have known conditions affecting fertility
Table of Contents
- When to Seek Help: Timing Guidelines
- Signs You Should See a Specialist Sooner
- Types of Fertility Specialists
- What to Expect at Your First Visit
- Common Fertility Tests
- Treatment Options
- Male Factor Infertility: The Other Half of the Equation
- Insurance Coverage for Fertility Testing and Treatment
- Preparing for Your First Fertility Appointment
- Emotional Aspects of the Fertility Journey
- Questions to Ask
- Frequently Asked Questions
When to Seek Help: Timing Guidelines
The standard recommendations for when to seek fertility help are based on age, as fertility declines with time. Understanding your menstrual cycle and ovulation patterns is the first step in determining whether you may need professional help.
Under Age 35
Consider seeing a specialist if you haven't conceived after 12 months of regular, unprotected intercourse timed around ovulation.
- About 80-85% of couples under 35 will conceive within 12 months
- Most fertility issues are treatable, so don't wait longer than a year
Ages 35-39
Consider seeing a specialist after 6 months of trying.
- Fertility begins declining more rapidly in the mid-30s
- Earlier evaluation means more time for treatment if needed
- Some doctors recommend testing at 3 months if you're closer to 40
Age 40 and Over
Consider seeing a specialist immediately or before you start trying.
- Fertility declines significantly after 40
- Egg quality and quantity decrease
- Time is a critical factor -- don't wait
- Preconception testing can identify potential issues early
Important Note: Trying Correctly
The timelines above assume you're actively trying to conceive with well-timed intercourse. "Trying" means:
- Having intercourse during your fertile window (5 days before ovulation through ovulation day)
- Using no contraception
- Intercourse at least every 2-3 days during the fertile window
If you haven't been timing intercourse to your fertile window, you may not have been maximizing your chances. Use our ovulation calculator and learn to recognize the signs of ovulation before concluding you need medical help.
| Age Range | Monthly Rate | When to Seek Help | Recommended Tests | Typical Treatment Path |
|---|---|---|---|---|
| Under 30 | 20-25% | After 12 months | Basic bloodwork, SA | OI, timed intercourse |
| 30-34 | 15-20% | After 12 months | AMH, Day 3 labs, SA, HSG | OI, IUI |
| 35-37 | 10-15% | After 6 months | Full workup including AMH, AFC | IUI, consider IVF |
| 38-40 | 8-10% | After 3-6 months | Comprehensive panel + genetic screening | IVF recommended |
| 41-42 | 5-8% | Immediately | Urgent full workup | IVF, consider donor eggs |
| 43+ | <5% | Before trying | Comprehensive assessment | IVF with donor eggs |
SA = Semen Analysis, OI = Ovulation Induction, AMH = Anti-Mullerian Hormone, AFC = Antral Follicle Count, HSG = Hysterosalpingogram
Signs You Should See a Specialist Sooner
Regardless of how long you've been trying, certain signs warrant earlier evaluation. If you experience irregular periods, that alone may be reason to consult a specialist earlier than standard timelines suggest.
For Women
- Irregular or absent periods: Cycles shorter than 21 days, longer than 35 days, or missing periods may indicate ovulation problems
- Very painful periods: Severe menstrual pain can be a sign of endometriosis
- Known reproductive conditions: Endometriosis, PCOS, fibroids, previous pelvic infections
- History of pelvic inflammatory disease (PID): Can cause tubal damage
- Previous ectopic pregnancy: May indicate tubal issues
- Multiple miscarriages: Two or more pregnancy losses warrant investigation
- Prior cancer treatment: Chemotherapy and radiation can affect fertility
- Thyroid disorders: Can affect ovulation and pregnancy
- Early menopause in family: May indicate reduced ovarian reserve
For Men
- Known low sperm count or motility
- History of testicular issues: Undescended testicles, injury, surgery
- Prior cancer treatment
- Erectile or ejaculation problems
- Genetic conditions in the family
For Both Partners
- Previous fertility issues: With current or past partners
- Known genetic conditions: May warrant preconception genetic counseling
- Concern or anxiety: If the uncertainty is affecting your mental health or relationship, seeking answers can provide peace of mind
- You have no periods or very irregular cycles (see our guide on ovulating with irregular periods)
- You or your partner have a known medical condition affecting fertility
- You are 40 or older
- You have had two or more miscarriages
- You or your partner had prior cancer treatment
Types of Fertility Specialists
Reproductive Endocrinologist (RE)
A reproductive endocrinologist is an OB/GYN who has completed additional fellowship training (3 years) in reproductive medicine. They are the primary specialists for fertility issues. The American Society for Reproductive Medicine (ASRM) maintains a directory of board-certified REs.
- Board certified in both OB/GYN and reproductive endocrinology
- Treat hormonal causes of infertility
- Perform advanced fertility treatments (IVF, IUI)
- Handle complex cases
Reproductive Urologist
A urologist with additional training in male fertility. They evaluate and treat male factor infertility.
- Perform semen analysis interpretation
- Diagnose causes of male infertility
- Treat varicoceles, blockages, and other male issues
- Perform surgical sperm retrieval if needed
OB/GYN
Your regular OB/GYN can start initial fertility testing and may treat simpler cases before referring to a specialist.
- Order basic bloodwork and ultrasounds
- Prescribe medications like Clomid
- Refer you to an RE for more complex treatment
What to Expect at Your First Visit
Your first fertility appointment typically takes 30-60 minutes and involves a thorough evaluation.
Before the Appointment
Gather the following information:
- Menstrual cycle history (cycle lengths, period duration, any irregularities) -- tracking with a fertility tracker app can help
- How long you've been trying to conceive
- Frequency and timing of intercourse
- Any tracking data (BBT charts, OPK results, apps)
- Medical history for both partners
- List of current medications and supplements
- Previous pregnancy history (including miscarriages, abortions, ectopic pregnancies)
- Any previous fertility testing or treatment
- Family history of fertility issues or genetic conditions
During the Appointment
The specialist will:
- Review your history: Detailed questions about your menstrual cycle, sexual history, medical history, and lifestyle
- Physical exam: May include a pelvic exam and potentially a vaginal ultrasound to check your ovaries and uterus
- Discuss testing plan: Explain which tests are recommended for both partners
- Set expectations: Discuss timeline, costs, and next steps
Both Partners Should Attend
Fertility affects both partners, and about 30-40% of infertility cases involve male factors. Having both partners present allows for:
- Complete history from both individuals
- Coordination of testing
- Shared understanding of the process
- Support for each other
Common Fertility Tests
For Women
| Test | What It Measures | When in Cycle | What Results Mean | Cost Range |
|---|---|---|---|---|
| Day 3 FSH/LH/Estradiol | Ovarian reserve and hormone levels | Cycle day 2-4 | High FSH may indicate low reserve; LH:FSH ratio helps diagnose PCOS | $200-$400 |
| AMH | Ovarian reserve (egg supply) | Any day | Lower AMH suggests fewer remaining eggs; helps predict IVF response | $80-$200 |
| Progesterone (Day 21) | Confirms ovulation occurred | 7 days post-ovulation | Level above 3 ng/mL suggests ovulation; above 10 is ideal | $50-$150 |
| Thyroid Panel (TSH) | Thyroid function | Any day | Abnormal thyroid can prevent ovulation and increase miscarriage risk | $50-$150 |
| Transvaginal Ultrasound | Ovaries (AFC), uterus, abnormalities | Early in cycle | AFC predicts ovarian reserve; identifies fibroids, cysts, polyps | $200-$500 |
| HSG | Fallopian tube patency, uterine shape | After period, before ovulation | Blocked tubes need IVF; some women conceive more easily after HSG | $500-$1,200 |
| Saline Sonogram (SIS) | Detailed uterine cavity view | After period, before ovulation | Identifies polyps, fibroids, or adhesions inside the uterus | $400-$800 |
| Prolactin | Pituitary function | Any day (morning best) | Elevated prolactin can suppress ovulation; often easily treated | $50-$100 |
For Men
- Semen analysis: The primary test for male fertility. Measures sperm count, motility (movement), morphology (shape), and volume. Usually requires 2-5 days of abstinence before the test.
- Hormone testing: FSH, LH, testosterone if semen analysis is abnormal
- Physical exam: Check for varicocele or other issues
Understanding when you ovulate is critical because many of these tests must be timed to specific cycle days. Use our ovulation calculator to identify your cycle pattern.
Treatment Options
Treatment depends on the cause of infertility. Options range from simple to complex, and most fertility clinics follow a stepwise approach:
Lifestyle Modifications
Sometimes recommended first, especially if there are controllable factors:
- Weight management (both overweight and underweight can affect fertility)
- Reducing alcohol and caffeine
- Quitting smoking
- Stress reduction
- Optimizing intercourse timing using tools like our ovulation calculator
Ovulation Induction
Medications to stimulate ovulation:
- Clomiphene citrate (Clomid): Oral medication that stimulates ovulation
- Letrozole (Femara): Another oral option, often preferred for PCOS
- Injectable gonadotropins: Stronger stimulation medications
Intrauterine Insemination (IUI)
Washed, concentrated sperm is placed directly in the uterus around ovulation time.
- Often combined with ovulation-inducing medication
- Less invasive than IVF
- Success rates: 10-20% per cycle depending on age and diagnosis
In Vitro Fertilization (IVF)
Eggs are retrieved, fertilized in a lab, and embryos are transferred to the uterus. According to CDC ART success rate data, IVF remains the most effective treatment for many types of infertility.
- Most effective treatment for many causes of infertility
- Higher success rates than IUI (varies by age but often 40-50%+ per cycle for women under 35)
- More invasive and expensive
- May include ICSI (injecting sperm directly into egg) for male factor
Surgery
May be recommended for:
- Removing fibroids or polyps
- Treating endometriosis
- Repairing blocked fallopian tubes
- Correcting male reproductive issues (varicocele repair)
| Treatment | Success Rate/Cycle | Average Cost | Time Commitment | Best For |
|---|---|---|---|---|
| Timed Intercourse + OI | 10-15% | $100-$500 | Minimal; 1-2 monitoring visits | Anovulation, mild unexplained |
| IUI (unmedicated) | 8-12% | $300-$1,000 | 1-3 office visits per cycle | Mild male factor, cervical issues |
| IUI + medications | 15-20% | $1,500-$4,000 | 3-5 office visits per cycle | Unexplained, mild male factor + anovulation |
| IVF | 40-50% (under 35) | $15,000-$25,000 | 2-4 weeks active; frequent visits | Tubal factor, severe male factor, age-related, failed IUI |
| IVF + ICSI | 40-50% (under 35) | $17,000-$28,000 | 2-4 weeks active; frequent visits | Severe male factor, prior fertilization failure |
| Donor Egg IVF | 50-60% | $25,000-$40,000 | 2-4 months (donor selection + cycle) | Diminished ovarian reserve, age 42+, genetic concerns |
Success rates are approximate and vary by clinic, patient age, and diagnosis. Source: SART and CDC ART data.
Male Factor Infertility: The Other Half of the Equation
Male factor infertility contributes to approximately 40-50% of all infertility cases, yet it is frequently overlooked in early conversations about conception. According to the American Society for Reproductive Medicine, a thorough evaluation of the male partner should be part of every initial fertility workup.
Understanding the Semen Analysis
A semen analysis is the cornerstone of male fertility testing. It evaluates several key parameters according to World Health Organization reference values:
- Sperm count (concentration): Normal is 15 million or more per milliliter. Low count (oligospermia) reduces the chances of an egg being fertilized naturally.
- Motility (movement): At least 40% of sperm should be motile. Poor motility (asthenospermia) means sperm have difficulty reaching the egg.
- Morphology (shape): At least 4% of sperm should have normal shape (strict criteria). Abnormal morphology (teratospermia) can affect fertilization ability.
- Volume: Normal ejaculate volume is 1.5 mL or more. Low volume may indicate a blockage or hormonal issue.
- Liquefaction and pH: Semen should liquefy within 20-30 minutes and have a pH of 7.2 or above.
Common Male Fertility Issues
- Varicocele: Enlarged veins in the scrotum, found in about 40% of infertile men. Often surgically correctable.
- Hormonal imbalances: Low testosterone, elevated FSH, or thyroid disorders can impair sperm production.
- Obstructive azoospermia: A blockage preventing sperm from reaching the ejaculate, despite normal production. Surgical repair or sperm retrieval may help.
- Non-obstructive azoospermia: Impaired sperm production due to genetic factors, prior chemotherapy, or unknown causes.
- Ejaculatory dysfunction: Retrograde ejaculation, erectile dysfunction, or premature ejaculation can prevent sperm from reaching the cervix.
Lifestyle Factors Affecting Male Fertility
Several modifiable factors can significantly impact sperm quality:
- Heat exposure: Avoid prolonged hot tub or sauna use, tight underwear, and laptop placement on the lap
- Smoking and tobacco: Reduces sperm count, motility, and morphology, and increases DNA fragmentation
- Alcohol: Heavy drinking lowers testosterone and impairs sperm production
- Obesity: Excess weight can alter hormone levels and reduce sperm quality
- Medications: Certain medications including testosterone supplements (paradoxically), anabolic steroids, and some antidepressants can impair fertility
- Recreational drugs: Marijuana and other substances can reduce sperm count and quality
When to See a Reproductive Urologist
A reproductive urologist should be consulted when:
- Semen analysis results are abnormal on two separate tests
- There is a history of testicular trauma, surgery, or undescended testicles
- Physical exam reveals a varicocele or other abnormality
- Hormonal testing shows imbalances
- The couple has unexplained infertility and the male partner hasn't been fully evaluated
Male Fertility Treatment Options
- Lifestyle modifications: Often the first step; improvements in sperm quality can be seen in 2-3 months (one full sperm production cycle is approximately 72 days)
- Hormonal therapy: Clomiphene citrate or gonadotropins can boost sperm production in men with hormonal deficiencies
- Varicocele repair: Microsurgical varicocelectomy improves sperm parameters in 60-70% of men
- Surgical sperm retrieval: TESE or micro-TESE can retrieve sperm directly from testicular tissue for use with IVF/ICSI
- IUI or IVF/ICSI: When male factor cannot be fully corrected, assisted reproductive technologies can bypass the issue
Insurance Coverage for Fertility Testing and Treatment
One of the most stressful aspects of the fertility journey is understanding what your insurance will and won't cover. The landscape of fertility insurance coverage in the United States is inconsistent, and coverage varies dramatically depending on your state, employer, and plan type.
The US Coverage Landscape
As of 2026, RESOLVE: The National Infertility Association reports that 21 states have passed fertility insurance laws, though the extent of mandated coverage varies significantly:
- States with IVF mandates: Connecticut, Delaware, Illinois, Maryland, Massachusetts, New Jersey, New York, Rhode Island, and others require insurers to cover IVF to varying degrees
- States with fertility treatment mandates (not IVF-specific): Some states require coverage for diagnosis and treatment but may exclude IVF
- States with no mandates: Many states have no fertility coverage requirements at all
Even in states with mandates, self-insured employer plans (common among large companies) may be exempt from state insurance laws under federal ERISA regulations.
What's Typically Covered vs. Not Covered
- Diagnostic blood tests (FSH, AMH, thyroid)
- Diagnostic ultrasounds
- HSG (hysterosalpingogram)
- Semen analysis
- Initial consultation visits
- Medications for underlying conditions (thyroid, PCOS)
- IVF procedures and monitoring
- IUI procedures
- Fertility medications (Clomid, injectables)
- Egg freezing (elective)
- Genetic testing of embryos (PGT)
- Donor eggs or sperm
- Surrogacy costs
Questions to Ask Your Insurance Provider
Before starting treatment, call your insurance company and ask these specific questions:
- Does my plan cover infertility diagnosis? What about treatment?
- Is there a lifetime maximum for fertility benefits? What is the dollar amount or cycle limit?
- Do I need a referral from my primary care doctor or OB/GYN?
- Are there specific fertility clinics in my network?
- What medications are covered under the pharmacy benefit?
- Is there a waiting period or requirement to try less invasive treatments first?
- Does coverage differ for diagnostic testing versus treatment?
- Are there age limits on fertility coverage?
Cost Estimates Without Insurance
If you are paying out of pocket, these are typical cost ranges for common fertility services in the United States:
- Initial consultation: $250-$500
- Basic diagnostic workup (both partners): $1,500-$3,500
- Clomid/Letrozole cycle with monitoring: $500-$1,500
- IUI cycle with medications: $1,500-$4,000
- IVF cycle (medications + procedure): $15,000-$25,000
- Frozen embryo transfer: $3,000-$5,000
- PGT-A genetic testing: $3,000-$6,000
Many clinics offer financing options, multi-cycle discounts, shared risk (refund) programs, and payment plans. Organizations like RESOLVE also maintain lists of grants and financial assistance programs for fertility treatment.
Preparing for Your First Fertility Appointment
Being well-prepared for your first fertility appointment can make the experience less stressful and help your specialist provide the best possible evaluation. Here is a step-by-step guide to getting ready.
What to Bring to Your Appointment
The more information you bring, the more productive your first visit will be:
Cycle Records
- At least 3-6 months of menstrual cycle data (start dates, lengths, flow patterns)
- Basal body temperature charts if you've been tracking
- Ovulation predictor kit (OPK) results
- Screenshots or exports from fertility tracking apps
- Notes on any cycle irregularities or unusual symptoms
Medical Information
- Complete list of current medications, vitamins, and supplements (including dosages)
- Previous medical records related to reproductive health
- Surgical history for both partners
- Any previous fertility test results or treatment records
- Insurance card and pre-authorization information if applicable
Family History
- History of infertility, miscarriage, or early menopause in female relatives
- Known genetic conditions on either side
- History of reproductive cancers in the family
- Birth defects or developmental disorders in the family
Questions to Prepare in Advance
Write down your questions before the appointment so you don't forget anything in the moment. Consider asking about:
- The clinic's success rates for your age group and diagnosis
- What the recommended testing timeline looks like
- How urgent your situation is given your age and history
- What you can do at home while waiting for results
- Whether there are any lifestyle changes that could help
Partner Involvement
Ideally, both partners should attend the first appointment. If your partner cannot attend in person, many clinics now offer telehealth options for the consultation portion. Having both partners present ensures:
- Both partners hear the same information directly from the specialist
- The male partner can provide his medical history accurately
- A semen analysis can be scheduled promptly
- Both partners feel involved in the decision-making process
- You can support each other emotionally during what can be a stressful visit
- 3-6 months of cycle tracking data (use our ovulation calculator to start)
- List of all medications, supplements, and vitamins
- Complete medical and surgical history for both partners
- Family history notes (both sides)
- Prior test results and medical records
- Insurance card and benefit details
- Written list of questions
- Calendar for scheduling follow-up tests
Emotional Aspects of the Fertility Journey
The fertility journey is not just a medical experience -- it is a deeply emotional one. Research published in peer-reviewed journals shows that the stress levels experienced by people going through infertility are comparable to those of people dealing with cancer, HIV, or chronic pain. Acknowledging and addressing the emotional component is just as important as the medical treatment itself.
Managing Expectations
One of the most challenging aspects of fertility treatment is the uncertainty. Here are strategies that can help:
- Educate yourself, but set boundaries: Learn about your diagnosis and treatment options, but avoid obsessive online searching that increases anxiety
- Take it one step at a time: Focus on the current cycle or phase of treatment rather than projecting outcomes months ahead
- Understand the statistics: Fertility treatment often takes multiple cycles. A 30% success rate per cycle does not mean failure -- it means cumulative success rates increase over time
- Have a plan for "what next": Discuss with your partner and specialist how many cycles you are comfortable with and when you would consider alternative paths
- Celebrate small wins: Good test results, a positive response to medication, or simply making it through a tough cycle are all worth acknowledging
Support Resources
You do not have to navigate this journey alone. Here are valuable resources:
- RESOLVE: The National Infertility Association: Offers support groups (in-person and virtual), educational events, and advocacy resources
- Online communities: Forums and social media groups where people share experiences. Look for moderated groups with evidence-based information
- Fertility clinic support: Many clinics have counselors, support groups, or patient navigators on staff
- Planned Parenthood: Provides information about fertility treatment options and reproductive health
- Books and podcasts: There are many well-researched resources available that can help normalize the experience
When to Seek Mental Health Support
Consider seeking professional mental health support if you experience:
- Persistent sadness, hopelessness, or depression that lasts more than two weeks
- Difficulty functioning at work or in daily life
- Withdrawal from social activities or avoidance of friends with children
- Relationship strain or conflict with your partner related to fertility
- Anxiety that interferes with sleep, eating, or concentration
- Feelings of guilt, shame, or blame (directed at yourself or your partner)
- Difficulty making decisions about treatment
Look for therapists who specialize in reproductive health or infertility. The ASRM Mental Health Professional Group can help you find specialists in your area.
Couples Counseling
Infertility can put significant strain on a relationship. Couples counseling can help with:
- Improving communication about feelings, fears, and hopes
- Navigating differing opinions about treatment (how far to go, when to stop)
- Maintaining intimacy when sex becomes associated with "trying"
- Processing grief and loss together (especially after failed cycles or miscarriage)
- Making difficult decisions as a team (such as considering donor gametes or adoption)
Support Groups
Both in-person and online support groups can be incredibly valuable:
- In-person groups: Many fertility clinics and hospitals host monthly support groups. RESOLVE also coordinates in-person peer support groups across the country.
- Online groups: Useful for people in rural areas or those who prefer anonymity. Look for groups facilitated by mental health professionals.
- Diagnosis-specific groups: Groups focused on PCOS, endometriosis, male factor, recurrent loss, or secondary infertility can provide targeted support.
- Faith-based groups: Some religious organizations offer fertility support groups that address the spiritual aspects of the journey.
- Infertility-related stress is real and valid -- you are not overreacting
- Seeking emotional support is a sign of strength, not weakness
- Your relationship and mental health matter as much as the medical outcome
- Professional help (therapy, counseling) is available and effective
- You are not alone -- millions of couples share this experience
Questions to Ask Your Fertility Specialist
About Your Diagnosis
- What do you think is causing our difficulty conceiving?
- Are there additional tests we should consider?
- What does each of our test results mean?
About Treatment Options
- What treatment do you recommend and why?
- What are the success rates for this treatment given our specific situation?
- What are the risks and side effects?
- How many cycles do you typically recommend before moving to the next option?
- Are there less invasive options we should try first?
About Practical Matters
- What are the costs? What does insurance cover?
- How frequently will we need appointments?
- What is the time commitment for treatment?
- How do we schedule urgent questions?
- What is your clinic's success rate for our age group/diagnosis?
About Next Steps
- What should we do while waiting for test results?
- Are there lifestyle changes that might help?
- When should we schedule a follow-up?
- Should we consider genetic counseling?
What to Expect at Your First Appointment
Walking into a fertility clinic for the first time can feel intimidating. Knowing exactly what to expect -- from the initial consultation through to your first treatment plan -- helps reduce anxiety and allows you to be a more engaged participant in your care. According to the National Infertility Association (RESOLVE), preparation is one of the most impactful things couples can do before their first fertility appointment. The American Society for Reproductive Medicine (ASRM) provides excellent patient-facing resources on what to bring and what questions to ask.
The Fertility Workup Process: A Step-by-Step Timeline
Pro Tip: Bring 3-6 months of cycle tracking data to your first appointment. Include cycle lengths, BBT charts, OPK results, and cervical mucus observations. This data can save an entire cycle of diagnostic testing and help your specialist understand your patterns immediately. The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines highlight that patient-provided cycle data is valuable for diagnosis and treatment planning.
Fertility Treatment Options Overview
Fertility treatment is not one-size-fits-all. Treatment is typically approached in a stepwise fashion, starting with less invasive and less expensive options and progressing to more advanced treatments if needed. The Johns Hopkins Medicine fertility centre and the Cleveland Clinic both provide detailed overviews of available treatments. Understanding the full range of options -- including approximate success rates and costs -- helps you make informed decisions and set realistic expectations.
Treatment Comparison: Success Rates, Costs, and Considerations
| Treatment | How It Works | Success Rate per Cycle | Approximate Cost (USD) | Typical Candidates | Number of Cycles Usually Tried |
|---|---|---|---|---|---|
| Timed intercourse + monitoring | Ultrasound monitoring to identify ovulation; intercourse timed to fertile window | 10-20% (age-dependent) | $200-500/cycle | Unexplained infertility; mild ovulatory issues | 3-6 cycles |
| Letrozole (Femara) | Oral medication that stimulates ovulation by lowering estrogen temporarily | 15-25% (first-line for PCOS) | $50-200/cycle + monitoring | PCOS; anovulation; irregular cycles | 3-6 cycles |
| Clomid (Clomiphene citrate) | Oral medication that blocks estrogen receptors, increasing FSH production | 10-20% per cycle | $50-150/cycle + monitoring | Anovulation; unexplained infertility | 3-6 cycles |
| IUI (Intrauterine insemination) | Washed, concentrated sperm placed directly in the uterus near ovulation | 10-20% per cycle | $300-1,000/cycle + meds | Mild male factor; unexplained; cervical issues | 3-4 cycles |
| Injectable gonadotropins + IUI | Hormone injections to stimulate multiple follicles, combined with IUI | 15-25% per cycle | $1,500-4,000/cycle | Failed oral medications; moderate infertility | 2-3 cycles |
| IVF (In vitro fertilisation) | Eggs retrieved, fertilised in lab, embryos transferred to uterus | 30-50% per transfer (age-dependent) | $12,000-15,000/cycle + meds ($3,000-5,000) | Tubal factor; severe male factor; endometriosis; failed IUI; age 38+ | 1-3 cycles typically |
| IVF with ICSI | Single sperm injected directly into each egg (used with severe male factor) | 30-50% per transfer | $14,000-18,000/cycle + meds | Severe male factor; previous fertilisation failure | 1-3 cycles |
| Donor eggs | Eggs from a younger donor used with partner's sperm; embryo transferred | 50-65% per transfer | $25,000-40,000 | Diminished ovarian reserve; repeated IVF failure; age 42+ | 1-2 cycles |
The success rates above are averages and vary significantly based on your specific diagnosis, age, ovarian reserve, and other factors. Women under 35 generally have higher success rates across all treatments. Your reproductive endocrinologist will provide personalised projections based on your test results. It is also worth noting that cumulative success rates (across multiple cycles) are substantially higher than per-cycle rates -- for example, while a single IVF cycle may have a 40% success rate, the cumulative rate after 3 cycles can exceed 70% for women under 35.
Questions to Ask Your Specialist
Coming to your fertility appointment with a prepared list of questions ensures you get the most out of your consultation time. The ASRM patient resources recommend that couples prepare questions in advance, as appointments can feel rushed and it is easy to forget important concerns in the moment. Below is a comprehensive list organised by category.
Comprehensive Questions List
About Your Diagnosis
- Based on our test results, what do you believe is the primary cause of our difficulty conceiving?
- Are there additional tests that might provide more information before we start treatment?
- Could there be multiple contributing factors, and if so, how do we prioritise addressing them?
- What is the prognosis for natural conception given our specific diagnosis?
About Treatment Planning
- What treatment approach do you recommend as a first step, and what is the evidence supporting it?
- What are the realistic success rates for this treatment for someone with my age and diagnosis?
- What are the potential side effects and risks of the recommended treatment?
- How many cycles of this treatment do you typically recommend before moving to the next option?
- What would be the next step if this treatment does not work?
- Are there lifestyle changes (diet, exercise, supplements) that could improve our chances alongside treatment?
About Practical and Financial Matters
- What is the total estimated cost for the recommended treatment, including medications, monitoring, and procedures?
- What portion is typically covered by insurance, and does your office help with insurance pre-authorisation?
- Do you offer payment plans, financing, or self-pay discounts?
- How frequently will I need to come in for monitoring appointments, and what is the time commitment?
- How do we reach the clinic for urgent questions or concerns outside office hours?
About Your Clinic
- What is your clinic's success rate for my age group and diagnosis? (Check CDC ART data independently as well.)
- How many of these procedures does your clinic perform per year?
- Will I see the same doctor throughout my treatment, or will I rotate among providers?
- What emotional support resources does your clinic offer or recommend?
- 1. What do you think is causing our difficulty conceiving, and are there additional tests we should consider?
- 2. What treatment do you recommend, and what are the realistic success rates for our specific situation?
- 3. What are the total costs, what does insurance cover, and what financing options are available?
- 4. How many cycles do you recommend before escalating to the next treatment option?
- 5. What is your clinic's success rate for our age group and diagnosis, and can you provide SART-verified data?
Remember, a good fertility specialist will welcome your questions and take time to explain things clearly. If you feel rushed, dismissed, or uncomfortable, it is perfectly acceptable to seek a second opinion. The doctor-patient relationship is important throughout the fertility journey. For more on tracking your cycle to bring data to your appointment, see our guides on signs of ovulation, BBT tracking, and fertility tracker apps.
Track Your Cycle
Bring your cycle data to your appointment. Our calculator can help you identify your patterns and recognize ovulation signs.
Try the CalculatorFrequently Asked Questions
Costs vary widely depending on treatment and location. Basic testing may cost $1,000-3,000. Medications like Clomid are relatively affordable ($50-150/cycle). IUI typically costs $300-1,000 per cycle plus medications. IVF averages $12,000-15,000 per cycle plus $3,000-5,000 for medications. Some insurance plans cover fertility treatment -- check your policy. Many clinics offer payment plans or financing. See our insurance coverage section for more details.
You can start with your OB/GYN for initial testing and possibly Clomid. However, if you're over 35, have known issues, or want comprehensive evaluation, going directly to a reproductive endocrinologist saves time. Some OB/GYNs will refer you to a specialist before trying treatment themselves. Either path is reasonable.
Absolutely not. Seeking help is being proactive about your health and family-building goals. About 1 in 6 couples face infertility -- it's very common. Many fertility issues are highly treatable when identified. Getting information empowers you to make decisions. Even if everything is fine, you'll have peace of mind.
About 10-15% of infertility cases are "unexplained" -- tests don't reveal an obvious cause. This doesn't mean nothing is wrong; it means our tests can't identify the issue. The good news: unexplained infertility often responds well to treatment. Many couples with unexplained infertility conceive with IUI or IVF. Your specialist can discuss treatment options.
Yes, in most cases. Many couples conceive naturally during the testing phase or between treatment cycles. Your doctor may advise whether intercourse is appropriate during specific treatment cycles (for example, IVF cycles may have intercourse restrictions). Continue timing intercourse to your fertile window unless instructed otherwise.
Yes, absolutely. Male factor infertility accounts for approximately 40% of all infertility cases. A semen analysis is one of the first and least invasive tests in a fertility workup. Testing both partners simultaneously saves time and provides a complete picture of your fertility as a couple. There is no reason to wait for the female partner's results before testing the male partner.
A basic fertility workup for both partners typically costs between $1,500 and $3,500 without insurance. This usually includes blood tests ($200-500), a semen analysis ($100-300), an HSG or saline sonogram ($500-1,200), and a transvaginal ultrasound ($200-500). Many insurance plans cover diagnostic testing even if they don't cover treatment. Ask your clinic about self-pay discounts, as many offer reduced rates for out-of-pocket patients.
Yes, you can see a fertility specialist at any time. While standard guidelines recommend 12 months for women under 35 and 6 months for women 35-39, there is no rule preventing earlier consultation. Proactive testing, sometimes called a "fertility check-up" or preconception assessment, can identify potential issues before they become time-critical. This is especially valuable if you have risk factors or simply want peace of mind.
An OB-GYN is a doctor specializing in general women's health, pregnancy, and childbirth. A reproductive endocrinologist (RE) is an OB-GYN who completed an additional 3-year fellowship in reproductive medicine and infertility. REs have specialized training in hormone disorders affecting reproduction, IVF and IUI procedures, surgical fertility procedures, and complex infertility cases. Think of it like the difference between a general practitioner and a cardiologist -- both are doctors, but one has additional specialized training.
Some online fertility clinics are legitimate and can be helpful for initial consultations, at-home hormone testing kits, and prescription of oral fertility medications like Clomid or Letrozole. However, they cannot replace in-person care for procedures like ultrasounds, HSG tests, IUI, or IVF. When evaluating online clinics, look for those staffed by board-certified reproductive endocrinologists, check their credentials through the ASRM or SART, and be cautious of services that make unrealistic promises or push expensive add-ons without evidence.
The timeline from your first consultation to beginning treatment typically spans 4-8 weeks. During the first visit, your specialist will review your history and order tests. Blood work (day 3 hormones) must be timed to your cycle, and an HSG or saline sonogram is usually performed between days 6-12. A semen analysis can be scheduled at any time. Once all results are in -- typically within 2-4 weeks -- your specialist will schedule a follow-up to discuss the diagnosis and treatment plan. Some treatments (like Clomid or letrozole) can begin the very next cycle after your plan is set. More complex treatments like IVF may require an additional 2-4 weeks for preparation, medication procurement, and scheduling. If you want to minimise delays, ask to schedule all tests as early as possible in the process.
The best objective source for comparing fertility clinic success rates in the US is the CDC's Assisted Reproductive Technology (ART) National Summary Report, which compiles data from all clinics annually. The Society for Assisted Reproductive Technology (SART) also publishes clinic-specific data. When comparing, look at success rates for your specific age group and diagnosis, not just overall averages. Be cautious of clinics that report unusually high success rates -- they may be selecting only the easiest cases. Also consider live birth rates (not just pregnancy rates), the number of cycles performed (larger samples are more reliable), and whether the clinic counts per transfer or per retrieval. Your diagnosis and age are the biggest factors in your personal success rate, regardless of which clinic you choose.
Evidence-based lifestyle changes that can improve fertility treatment outcomes include maintaining a healthy BMI (18.5-24.9), taking a prenatal vitamin with at least 400 mcg of folic acid daily, reducing or eliminating alcohol consumption, quitting smoking (smoking reduces IVF success rates by up to 50%), limiting caffeine to under 200 mg per day, engaging in moderate regular exercise (avoiding extremes), managing stress through mindfulness or counselling, and ensuring 7-9 hours of quality sleep. For male partners, avoiding excessive heat exposure (hot tubs, laptops on lap), reducing alcohol, stopping smoking, and maintaining a healthy weight can improve sperm parameters. Start these changes ideally 3 months before treatment, as it takes approximately 3 months for both eggs and sperm to mature. Bring your cycle tracking data to your appointment to help your specialist assess your baseline.
Medical Disclaimer
This article provides general information and is not a substitute for personalized medical advice. If you're concerned about your fertility, please consult with a qualified healthcare provider who can evaluate your specific situation. For emergency medical concerns, contact your doctor or go to the nearest emergency room.
Sources & References
- ACOG Committee Opinion No. 589. "Female Age-Related Fertility Decline." ACOG
- Practice Committee of ASRM. "Diagnostic evaluation of the infertile female." Fertility and Sterility, 2015. PubMed
- NICE. "Fertility problems: assessment and treatment." Clinical guideline CG156, 2013. NICE
- CDC. "ART Success Rates." CDC ART Data
- RESOLVE: The National Infertility Association. "Insurance Coverage by State." RESOLVE
- WHO. "WHO Laboratory Manual for the Examination and Processing of Human Semen." 6th Edition, 2021. WHO
- Practice Committee of ASRM. "Diagnostic evaluation of the infertile male." Fertility and Sterility, 2015. PubMed
- Mayo Clinic. "Infertility - Diagnosis and Treatment." Mayo Clinic
- Healthline. "How Much Does IVF Cost?" Healthline
- Planned Parenthood. "Fertility Treatments." Planned Parenthood