Fertility & IVF
When to See a Fertility Specialist: Timelines, Red Flags and What to Expect
Most people should see a fertility specialist after 12 months of regular unprotected sex without a pregnancy if they're under 35, or after 6 months if they're 35 or older. If you're over 40, have very irregular periods, or have a known condition that affects fertility, you can be evaluated right away. These timelines come from the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG).
The most common thing people say at a first fertility visit is some version of "I wish I'd come sooner." The second most common is "I didn't know I was allowed to." You are. Those 6- and 12-month marks are the longest you should wait, not a waiting period you have to serve.
A fertility specialist is usually a reproductive endocrinologist and infertility (REI) specialist: an OB/GYN with several extra years of training in hormones, ovulation, IVF and related care. Browse REI doctors across New York on our reproductive endocrinology and infertility page.
What counts as infertility?
ASRM defines infertility as not getting pregnant after 12 months of regular, unprotected intercourse or donor insemination, or after 6 months for women 35 and older. New York's insurance regulators use the same definition when deciding what plans must cover.
The definition also says earlier evaluation is appropriate when your history or exam suggests a problem.
Find your timeline
| Your situation | When to get evaluated |
|---|---|
| Under 35, regular periods, no known issues | After 12 months of trying |
| 35 to 39 | After 6 months of trying |
| 40 or older | Right away, or as soon as you start trying |
| Irregular or absent periods | Right away |
| Known tubal, uterine or male factor issue | Right away |
| Two or more pregnancy losses | Right away |
| Single, LGBTQ+, or using donor sperm | Whenever you're ready to plan |
Age matters because the number and quality of eggs decline over time. ACOG notes that fertility drops gradually in the early 30s and faster after about 37. Getting tested sooner doesn't mean you'll need IVF. It means you'll have more options if something turns up.
Red flags: don't wait
Ask for an evaluation now, without waiting 6 or 12 months, if any of these apply:
- Irregular periods, cycles longer than about 35 days, or no periods at all
- Known or suspected PCOS, endometriosis or fibroids
- A history of pelvic infection, such as chlamydia or pelvic inflammatory disease, which can damage the tubes
- A past ectopic pregnancy or surgery on the tubes or ovaries
- Two or more miscarriages
- Past cancer treatment, or upcoming treatment that could affect fertility
- A partner with known sperm issues, past testicular surgery, undescended testicles, or erectile or ejaculation problems
- Severe pelvic pain with periods or sex
If you have thyroid disease, diabetes, a clotting disorder or another medical condition, talk with your doctor before trying so it's well controlled.
OB/GYN first, or straight to a specialist?
Both work.
Your OB/GYN or primary care doctor can often:
- Review your cycle history and confirm ovulation
- Order first-line bloodwork, such as thyroid tests
- Order a semen analysis for a male partner
- Order an ultrasound or a test to check the fallopian tubes
- Prescribe oral ovulation medicine in some cases
A reproductive endocrinologist is the right next step when:
- Basic testing finds a problem that needs advanced treatment
- You're 35 or older and have been trying 6 months or more
- A few rounds of ovulation medicine haven't worked
- You're thinking about IUI, IVF, egg freezing or donor options
If you're not sure, start with whoever can see you soonest. Many New Yorkers save time by going straight to an REI practice. See what happens at a first fertility appointment.
What the workup actually involves
A standard evaluation checks the main things a pregnancy needs. Here's what each test is like:
- Ovulation: Are eggs released each month? Cycle history plus a blood draw.
- Ovarian reserve: Roughly how many eggs remain? An AMH blood test and a transvaginal ultrasound to count follicles, usually early in your cycle.
- Fallopian tubes: Are they open? Usually an HSG, an X-ray with dye through the cervix. It takes a few minutes and causes strong cramps for many people; ask about taking a pain reliever beforehand.
- Uterus: Any polyps, fibroids or other issues inside? Often checked during the ultrasound or with a saline sonogram.
- Sperm: A semen analysis checks count, movement and shape.
Male factors play a role in a large share of couples, so both partners should be tested at the same time. Testing one partner at a time can add months.
Most of the workup fits within one or two menstrual cycles. A practical point for New Yorkers: several tests are timed to specific cycle days and often scheduled early in the morning, so ask whether the practice has a satellite office near home or work.
Does insurance cover a fertility evaluation in New York?
New York law requires many fully insured plans to cover the diagnosis and treatment of infertility, including testing and IUI. Since January 1, 2020, insured large-group plans (employers with more than 100 workers) must also cover up to three IVF cycles. All insured individual, small-group and large-group plans must cover medically necessary fertility preservation.
Limits to know:
- Self-funded employer plans are regulated by federal law, not New York, so the state mandate doesn't apply to them.
- Medicaid, the Essential Plan and Medicare aren't covered by the IVF mandate.
- Deductibles, copays and prior authorization can still apply.
Our full guide to New York's IVF insurance law has details.
Before your first visit: a checklist
- Track your periods for a few months: start dates, length and any spotting.
- Gather records of past pregnancies, surgeries, imaging and labs.
- List your medicines and supplements.
- Call your insurer and ask: Do I need a referral? Which REI practices are in network? Is IVF covered under my plan?
- If you have a partner, plan for their semen analysis too.
Most adults planning a pregnancy should already be taking a daily prenatal vitamin with folic acid, as the CDC recommends. Ask your clinician which one.
When to see a doctor
Book with a fertility specialist or your OB/GYN if:
- You're under 35 and have been trying for 12 months
- You're 35 to 39 and have been trying for 6 months
- You're 40 or older and want to conceive
- You have irregular periods, a known reproductive condition, or two or more losses
- You need to protect your fertility before cancer treatment or other medical care
Get urgent care right away for severe one-sided pelvic pain, heavy bleeding or fainting, especially if you could be pregnant. These can be signs of an ectopic pregnancy.
Finding a fertility specialist in New York
Fertility practices in the New York area cluster in Manhattan, with offices across Long Island, Westchester and the other boroughs. Many run satellite offices for early-morning monitoring, which matters when you need frequent ultrasounds. Start with Manhattan fertility specialists, or check Suffolk County and other counties.
Frequently asked questions
How long should you try to get pregnant before seeing a fertility doctor?
Medical groups recommend an evaluation after 12 months of regular unprotected sex if you're under 35, and after 6 months if you're 35 or older. If you're over 40, testing is reasonable right away.
Do I need a referral to see a fertility specialist in New York?
It depends on your insurance. HMO and EPO plans often require a referral from a primary care doctor or OB/GYN, while many PPO plans don't. Call your plan before booking.
Should I see a fertility specialist if my periods are irregular?
Yes. Irregular or absent periods can mean you aren't ovulating regularly, which is a common and often treatable cause of infertility. You don't need to wait a full year to be evaluated.
Can my OB/GYN start fertility testing?
Yes. Many OB/GYNs order first-line tests such as bloodwork, an ultrasound and a semen analysis for a partner, and refer to a reproductive endocrinologist if treatment beyond basic options is needed.
Sources
- ASRM — Definitions of infertility and recurrent pregnancy loss: a committee opinion
- ASRM — Fertility evaluation of infertile women: a committee opinion
- ACOG — Female Age-Related Fertility Decline (Committee Opinion 589)
- CDC — Infertility FAQs
- NY DFS — Infertility Coverage Consumer FAQ
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.