• Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment.
• If you’re between 35 and 40, discuss your concerns with your doctor after six months of trying.
• If you’re older than 40, your doctor might suggest testing or treatment right away.

Your doctor might also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.

Infertility in men is most often caused by:

• Problems making sperm or producing too few sperm or none at all
• Problems with the sperm’s ability to reach the egg and fertilize it
• Abnormal sperm shape or structure prevent it from moving correctly

In women, a number of factors can disrupt the conception process at any step. Female infertility is caused by one or more of the factors below

Ovulation disorders

Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders.

Damage to fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

1. Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
2. Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube

Endometriosis

Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also disrupt implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Uterine or cervical causes

Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:

1. Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
2. Problems with the uterus present from birth, such as an unusually shaped uterus, can cause problems becoming or remaining pregnant.
3. Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
4. Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Unexplained infertility

In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem can correct itself with time. But you shouldn’t delay treatment for infertility.

• Maintain a healthy weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than five hours a week has been associated with decreased ovulation.
• Quit smoking. Tobacco has multiple negative effects on fertility, as well as your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol. Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing fetus. If you’re planning to become pregnant, avoid alcohol, and don’t drink alcohol while pregnant.
• Reduce stress. Some studies have shown that stress can cause couples to have poorer results with infertility treatment. Try to reduce stress in your life before trying to become pregnant.