Most people won’t know they’re infertile from symptoms alone. Infertility is defined by time: if you’re under 35 and haven’t conceived after 12 months of regular, unprotected sex, that’s when the diagnosis applies. For those 35 to 40, the window shortens to six months. If you’re over 40, evaluation should begin right away. But certain physical signs and risk factors can point to fertility problems before you ever start trying.
Signs That May Affect Female Fertility
Your menstrual cycle is one of the most accessible clues. A cycle shorter than 21 days, longer than 35 days, or one that’s highly irregular or absent altogether can signal that you’re not ovulating. Without ovulation, pregnancy can’t happen. Periods that are extremely painful, especially pain that worsens over time, may point to endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus and can interfere with conception.
Polycystic ovary syndrome (PCOS) is another common cause of ovulation problems. It creates a hormone imbalance that can show up as unusual hair growth on the face or body, persistent acne, weight gain, or long gaps between periods. A history of pelvic inflammatory disease, repeated miscarriages, or prior cancer treatment also raises the likelihood of fertility issues. None of these signs guarantee infertility, but they’re worth flagging early rather than waiting the full 12 months before seeking evaluation.
Signs That May Affect Male Fertility
Male factors contribute to roughly half of all cases where a couple can’t conceive, yet men often assume the issue lies elsewhere. Physical signs to watch for include difficulty maintaining an erection, problems with ejaculation, noticeably low volume of ejaculate, or reduced sex drive. Pain, swelling, or a lump in the testicle area also warrants attention.
Less obvious signs include decreased facial or body hair, which can indicate a hormonal imbalance, or unusual breast tissue growth. A varicocele, which is a swelling of the veins that drain the testicle, is the most common reversible cause of male infertility. It sometimes feels like a soft lump above the testicle or causes a dull ache. A history of undescended testicles, testicular trauma, or infections like gonorrhea can also damage sperm production or block sperm from reaching the ejaculate.
What You Can Track at Home
Before seeing a doctor, you can gather useful information about whether you’re ovulating. Two common methods are ovulation predictor kits and basal body temperature tracking.
Ovulation predictor kits (sold at most pharmacies) test your urine for a hormone surge that happens one to two days before ovulation. They’re straightforward and give you a same-day result. Basal body temperature tracking is more involved: you take your temperature every morning before getting out of bed, after at least three hours of uninterrupted sleep, using a thermometer sensitive enough to detect small changes. After ovulation, your resting temperature rises by less than half a degree Fahrenheit and stays elevated for three or more days. If you never see that sustained rise over several months, you may not be ovulating consistently.
These methods are most useful for identifying patterns over two or three cycles. They can tell you whether ovulation is happening, but they can’t evaluate egg quality, fallopian tube health, or sperm factors. Think of them as a starting point, not a diagnosis.
Lifestyle Factors That Lower Fertility
Smoking reduces fertility in both men and women. It can disrupt hormone production, damage sperm DNA, and harm the reproductive system even through secondhand exposure. If you smoke and are trying to conceive, quitting is one of the most impactful changes you can make.
Body weight matters too. Being significantly underweight or overweight can disrupt ovulation in women, and obesity is closely linked with PCOS. In men, excess weight can lower testosterone and affect sperm quality. Heavy alcohol use and chronic stress also play a role, though their effects are harder to quantify precisely. None of these factors make conception impossible on their own, but they can meaningfully reduce your chances each cycle.
What Happens During a Fertility Evaluation
If the timeline or your symptoms suggest a problem, a doctor will typically evaluate both partners. For women, one of the first tests is a blood draw to measure anti-Müllerian hormone, or AMH. This gives an estimate of your ovarian reserve, meaning roughly how many eggs remain in your ovaries. It doesn’t measure egg quality or predict whether you’ll get pregnant, but it helps your doctor understand how your body might respond to fertility treatment. The test is simple, takes less than five minutes, and doesn’t require any preparation. High AMH levels can also be a sign of PCOS.
Other blood tests check hormone levels related to ovulation, thyroid function, and the pituitary gland. An ultrasound can visualize the ovaries and uterus, and a specialized X-ray called a hysterosalpingogram checks whether the fallopian tubes are open. Endometriosis, one of the more difficult conditions to pin down, often requires a surgical procedure called laparoscopy for a definitive diagnosis, though a doctor may suspect it based on pain patterns, a physical exam, or ultrasound findings showing cysts on the ovaries.
For men, the primary test is a semen analysis, which evaluates sperm count, movement, and shape. It’s noninvasive and usually one of the first steps ordered. If results are abnormal, further testing might include hormone blood work or an ultrasound of the testicles.
When to Start the Conversation
If you’re under 35 with no concerning symptoms, most guidelines suggest trying for a full year before pursuing testing. But you don’t need to wait that long if you have irregular or absent periods, a known condition like PCOS or endometriosis, a history of pelvic infections, or prior cancer treatment. The same applies if your male partner has a history of testicular problems, known hormonal issues, or prior infections that could affect sperm. In these cases, starting the evaluation earlier can save months of uncertainty and open up treatment options sooner.
For those 35 to 40, six months of trying is the threshold. Over 40, there’s no recommended waiting period at all. Age is the single strongest predictor of female fertility, and egg quantity and quality decline more steeply after 35. That doesn’t mean conception is impossible, but it does mean earlier evaluation gives you more options.