You Just Got a Fertility Diagnosis. Here’s What Should Happen Next.
Most couples leave that first appointment with a label and a brochure. What they actually need is a plan that starts with the right questions, not the most expensive treatment.
Sarah and David had been trying for 14 months. Their doctor said “infertility” and referred them straight to an IVF clinic. Nobody checked David’s sperm. Nobody asked about Sarah’s cycles. Nobody mentioned that David’s BMI was 34 or that Sarah had irregular periods every 40 to 45 days.
Eight months and $22,000 later, their IVF cycle failed. A second opinion revealed David had a varicocele and Sarah had PCOS. After varicocele repair, weight loss coaching for David, and ovulation induction for Sarah, they conceived without IVF.
This story is not unusual. And the reason it keeps happening is that too many couples skip the most important part of the fertility journey: finding out why.
What “Infertility” Actually Means
Let’s start with the basics. Infertility is defined as failure to achieve pregnancy after 12 months of regular, unprotected intercourse. For women over 35, that window shortens to 6 months. For women over 40, evaluation should begin immediately.
But here’s what most people don’t realize: infertility is not a diagnosis. It’s a description. Saying you have “infertility” is like saying you have “pain.” It tells you something is wrong. It tells you nothing about what or why.
The real work, the work that determines whether you spend years and tens of thousands of dollars on treatments that may not address your actual problem, begins with a proper evaluation. And that evaluation must include both partners from the start.
The Evaluation: Both Partners, at the Same Time
This is one of the most important things I can tell you. The 2024 AUA/ASRM guideline is explicit: clinicians should initiate concurrent assessment of both the male and female partner. Not “evaluate the woman first and then maybe check the man.” Both. Together. From the beginning.
Why? Because male factors contribute to infertility in roughly half of all couples. The ACOG Infertility Workup clinical practice guideline states that male factor is a cause of infertility in 40 to 50% of couples. Skipping the male evaluation doesn’t just waste time. It can lead to unnecessary, invasive, and expensive treatment of the female partner for a problem that originates with the male partner.
