Fertility Problems: When to See a Doctor and Which Tests
Medically Reviewed by Dr. Pedro Yelamo Vera, MD
Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 5 November 2026
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Fertility problems mean a couple has not got pregnant after a year of regular sex without contraception. See a doctor after six months if the woman is 36 or over, or sooner if there is a known problem. First tests are a semen test for the man, and hormone blood tests and a scan for the woman. This guide is by Dr. Pedro Yelamo Vera, an English-speaking GP licensed in Spain (Colegiado No. 484814280) who sees patients by video in English and Spanish.
- More than 8 in 10 couples where the woman is under 40 get pregnant within a year.
- See a doctor after a year of trying, after six months if the woman is 36 or over, or sooner with irregular periods or a known problem.
- The cause can lie with the woman, the man or both. In about a quarter of couples no cause is found.
- Men are checked with a semen analysis. Women have hormone tests, a progesterone test and a scan.
- The AMH test estimates egg supply, but it cannot on its own predict whether you will get pregnant.
- Stopping smoking, cutting alcohol and keeping a healthy weight help both partners.
When is it called infertility?
When there is no pregnancy after 12 months of regular sex without contraception. The NHS says about 1 in 7 couples have trouble conceiving. After three years of trying, the chance of a natural pregnancy in the next year falls to about 1 in 4 or less. In Spain the word is infertilidad.
When should I see a doctor about fertility problems?
- After a year of trying, if the woman is under 36.
- After six months, if the woman is 36 or over.
- Sooner, with very irregular or missed periods, endometriosis, a past pelvic infection or surgery on the tubes.
- Sooner, if the man has had testicle problems, surgery in that area or cancer treatment.
What causes fertility problems?
In women, the most common causes are not ovulating regularly (for example with PCOS, thyroid problems or high prolactin), tubes that are blocked or damaged by infections such as chlamydia, endometriosis, and age, as fertility falls over the years.
In men, the main cause is poor semen quality: too few sperm, or sperm that do not swim well. Factors include a varicocele (swollen veins in the scrotum), infections, testicle problems, smoking, alcohol, obesity, heat and using testosterone or anabolic steroids. These can shut down sperm production.
Which tests come first?
Both partners are checked, not only the woman. A GP can start with:
- Semen analysis for the man.
- Progesterone blood test in the second half of the cycle, to confirm ovulation.
- Hormone tests early in the cycle, plus thyroid and prolactin if periods are irregular.
- Infection tests, such as for chlamydia.
- Pelvic ultrasound scan to look at the womb and ovaries.
After that, a gynaecologist or fertility unit may test the tubes or order more detailed tests.
What does a semen analysis measure?
It measures the amount of semen and the number, movement and shape of the sperm. Before the test you are asked not to ejaculate for about 2 to 3 days, and not for more than 5, as the sample gets worse. An abnormal result is usually repeated, because semen varies from one sample to the next. In Spain it is called a seminograma.
What is the AMH test?
Anti-Müllerian hormone (AMH) is a blood test. It estimates how many eggs are left in the ovaries, called the ovarian reserve. It falls with age. It helps plan fertility treatment. But it does not tell you about egg quality, and on its own it cannot predict a natural pregnancy. Your doctor reads it alongside your age and other tests.
What treatments are there?
They depend on the cause. Options include medicines to help you ovulate, surgery in some cases, artificial insemination (IUI) or IVF. A fertility unit plans and runs them, not a GP. In Spain, the public health system offers assisted reproduction, with entry rules and waiting lists.
What can I do to improve fertility?
- Both partners stop smoking, and avoid other people's smoke.
- Cut down on alcohol. If you are trying for a baby, not drinking is safest.
- Keep a healthy weight. A BMI of 30 or more lowers fertility.
- Have sex every two or three days through the cycle, without fixating on fertile days.
- Take folic acid before pregnancy, as your doctor advises.
- Review your medicines with a doctor before you start trying.
When to see a doctor sooner
- Periods that stop, are very painful or very irregular.
- Pain during sex.
- Unusual discharge or signs of a sexually transmitted infection. Read about chlamydia.
- Lumps, pain or changes in the testicles.
- Problems with erections or ejaculation.
When to call 112
If you have a positive pregnancy test with strong pain on one side of the tummy, bleeding, dizziness or fainting, call 112. It could be an ectopic pregnancy.
Frequently asked questions about fertility problems
Is infertility always the woman's problem?
No. The cause can lie with the man, the woman or both. That is why both partners are tested from the start.
Can stress cause infertility?
Stress can lower sex drive and, if severe, affect ovulation and sperm. It is rarely the only cause.
At what age does fertility drop?
In women it falls slowly from the thirties and faster after 35. In men it also falls with age, but more slowly.
Does a low AMH mean I cannot have children?
Not always. It means fewer eggs in reserve, but many women with low AMH get pregnant. Your doctor reads it with other tests.
Can I start fertility tests by video consultation?
Yes. A doctor can review your history, order the first blood tests and the semen analysis, and guide referral to a gynaecologist or fertility unit.
Getting a medical assessment
If you are in Spain and have been trying for a baby for a while, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about pregnancy and planning a pregnancy and about PCOS. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.
This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.
Sources
This content is written and reviewed by a licensed physician with reference to the following sources.
