Infertility is usually defined as a year of trying without a pregnancy, or six months once the woman is past thirty-five, and a great deal of it is workable. The pieces with the most behind them are simple: time sex to the fertile window, take folic acid before conceiving, use letrozole for the common ovulation problem of PCOS, and treat the male half, since a male factor is involved in about half of couples. Several popular additions do less than they promise. Acupuncture around IVF did not raise live births in the large trials, a paid IVF add-on called endometrial scratching made no difference, and requiring weight loss before treatment did not lift the birth rate in the trial that tested it.
For couples who blame themselves, the evidence is clear: emotional distress does not cause infertility and does not lower the chance that treatment works. Smoking and heavy drinking do lower the odds, and those are worth changing. And there is a right time to be evaluated rather than to keep waiting.
Practice Ranking
Every practice we track for Fertility & Trying to Conceive, ranked by how well the evidence supports it for this condition. Strength describes the evidence, not our endorsement.
2 practices · 1 to start with
| # | Practice | Evidence | Type | Cost | Effort | Results In | Add to plan |
|---|---|---|---|---|---|---|---|
| 1 | Quitting Smoking Smoking lowers fertility in both partners; quitting helps. | Moderate | Pro | Free to $$ | Hard | Days to Longer | |
| 2 | Reduce Alcohol Cutting heavy drinking is a reduce-lever while trying to conceive. | Emerging | Self-Directed | Free | Moderate to Hard | Weeks to Months | |
Default order puts the best-supported practices first, with self-directed care ahead of clinical options. Click any row to open the practice.
What It Is
Infertility is usually defined as a year of regular, unprotected sex without a pregnancy, or six months once the woman is past thirty-five, when time matters more. That threshold is not a verdict. Given well-timed trying, most couples conceive within a year: cumulative conception reaches about 68% by three cycles, 81% by six, and 92% by twelve, so the odds are with you at the start, and the year mark is chosen because beyond it roughly half of those still trying have a cause worth finding.
Trying to conceive is a couple matter. A male factor is present in about half of couples who struggle, on its own or alongside a female cause, which is why a semen analysis belongs early in the workup, before months spent looking only at the woman. The causes divide roughly into thirds:
- about a third of cases trace mainly to the woman,
- a third mainly to the man,
- the rest to both partners, or to no cause that testing can find.
That last group, unexplained infertility, is frustrating, and it does not mean nothing can be done: many of these couples conceive with time or with treatment.
Conception is nearly confined to a narrow stretch each cycle. The fertile window is the six days ending on the day of ovulation, with the best odds in the two or three days just before it. Tracking that window by cycle length, ovulation kits, or cervical mucus is one of the simplest things that raises the monthly chance.
Age is part of the biology, for both eggs and sperm. The per-cycle chance of conceiving falls gradually through the twenties and early thirties and more steeply from the mid-thirties, with a smaller parallel decline on the male side. This is biology, not fault, and it is the reason to be evaluated early when time is short. It is average data, not a personal prediction: fertility varies widely between people of the same age, and many older couples conceive without difficulty.
What Helps
The pieces with the most behind them are the plainest ones. The clinical treatments matched to a specific cause sit on top of those, and the ladder below grades the full research.
Timing comes first, because it is free and it works. Conception happens only in the six-day fertile window ending on ovulation, so regular sex every one to two days across the week leading up to and including ovulation covers the days that count. This is the one change every couple can make from the first month.
Folic acid before conception is standard preconception care. Around the time of conception it cuts the risk of serious spine and brain defects in the baby, by about 72% in women at high risk in the trial that established it. It protects the pregnancy; it does not raise the chance of conceiving. Start it before you try.
For the common ovulation problem of polycystic ovary syndrome, letrozole changed practice. In women with PCOS who are not ovulating, letrozole gave more live births than the older clomiphene, 27.5% against 19.1% over up to five cycles, with higher ovulation rates and no rise in serious birth defects. It is a prescribed treatment monitored by a clinician, and it is specific to anovulatory PCOS, not unexplained infertility.
The biggest gains come from naming the cause and treating it:
- ovulation induction for a PCOS ovulation problem,
- surgery or IVF for blocked tubes,
- the right treatment for a male factor.
The male side needs its own workup from the start. Because a male factor contributes to about half of couples who struggle, an early semen analysis gives the couple a full picture, and many male causes can be treated, bypassed with assisted reproduction, or modified by stopping smoking, keeping the testes cool, and assessing a varicocele. The male fertility guide covers this side in full.
The supplement picture is weaker. For men, an antioxidant supplement may raise the chance of a live birth, but the trials behind that are few, small, and low quality, so the signal is uncertain. It is low-cost and low-risk if a man wishes to try it alongside the free basics.
For women, general antioxidant supplements have not been shown to improve the chance of a live birth, and a large review of them has since had several of its trials retracted, so there is no clear benefit to point to.
Chinese herbal medicine has an early signal too: pooled studies link it with higher pregnancy rates, but the trials are small and low quality, so the true effect is likely much smaller than those pooled numbers suggest. Use it with a qualified practitioner alongside a full workup, not in place of treatment matched to the cause.
Two habits lower the odds and are worth changing: smoking and heavy drinking.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Fertility
Letrozole beat clomiphene for PCOS live births, 27.5% versus 19.1%
For women with polycystic ovary syndrome who are not ovulating, the drug letrozole works better than the older clomiphene: more ovulation and more live births, with no rise in serious birth defects.
The PPCOS II trial randomized 750 women with PCOS to letrozole or clomiphene for up to five cycles. Cumulative live-birth rate was 27.5% with letrozole versus 19.1% with clomiphene (rate ratio 1.44, 95% CI 1.10 to 1.87), with higher cumulative ovulation and pregnancy rates. There were four major congenital anomalies with letrozole and one with clomiphene, a difference that was not statistically significant. On the strength of this trial, letrozole became a first-line agent for ovulation induction in PCOS. It applies to anovulatory PCOS specifically, not to unexplained infertility or other causes.
Ovulation induction is a prescribed treatment monitored by a clinician; letrozole is the preferred first-line agent for anovulatory PCOS, and the choice and dose are made with the person managing your care.
The study · 1
Legro 2014, N Engl J Med · N Engl J Med
Folic acid before conception cut neural-tube defects by 72%
Taking folic acid before and in early pregnancy sharply cuts the risk of serious spine and brain defects in the baby. It is standard preconception care. It does not make you more fertile; it protects the pregnancy once it happens.
The MRC Vitamin Study was a randomized, double-blind trial across 33 centers in seven countries in women at high risk because of a previous affected pregnancy. Folic acid (4 mg daily) around the time of conception reduced the recurrence of neural-tube defects by 72% (relative risk 0.28, 95% CI 0.12 to 0.71). Other vitamins showed no such effect. This established periconceptional folic acid as standard preconception care and underlies the general advice to start folic acid before trying. The benefit is prevention of a birth defect, not an increase in the chance of conceiving, which is a common misunderstanding worth being clear about.
Start folic acid before you try to conceive, at the standard preconception dose, or a higher dose if you have had an affected pregnancy or another risk factor, as advised by your clinician. It protects the pregnancy rather than boosting fertility.
The study · 1
Endometrial scratching did not improve IVF live births, 26.1% versus 26.1%
A popular paid add-on to IVF, scratching the lining of the womb before a cycle, made no difference to the number of babies in a large trial. It stands for a wider pattern of expensive IVF extras that promise more than they deliver.
A 2019 international randomized trial (New England Journal of Medicine) assigned 1364 women undergoing IVF to endometrial scratching or no scratching before their cycle. Live birth occurred in 26.1% of both groups (adjusted odds ratio 1.00, 95% CI 0.78 to 1.27), with no difference in ongoing pregnancy, clinical pregnancy or miscarriage. Endometrial scratching had been widely offered and charged for on the theory it improves implantation; this trial found no benefit. It is a concrete example of the broader problem of IVF add-ons marketed ahead of the evidence, and a reason to ask what any extra actually adds before paying for it.
Before paying for any IVF add-on, ask what randomized evidence shows it improves live births; for endometrial scratching specifically, a large trial showed no benefit, so it is a cost without a demonstrated return.
The study · 1
Lensen 2019, N Engl J Med · N Engl J Med
Conception happens only in the six days ending on ovulation
You can only conceive in a narrow six-day stretch each cycle, ending on the day the egg is released. Targeting that window, instead of a single calendar day, is one of the simplest things that raises the monthly odds.
In a prospective cohort, 221 healthy women planning pregnancy recorded intercourse daily and identified ovulation by urinary hormone metabolites. Conception was virtually confined to a six-day interval ending on the day of ovulation, with the highest probability from intercourse in the two days before ovulation. No pregnancies followed intercourse outside this window. The finding maps the biology of the fertile window and is the basis for advice to have regular intercourse across the days leading up to ovulation rather than trying to hit a single day.
Aim for intercourse every one to two days across the week leading up to and including ovulation, rather than saving it for a single predicted day. Ovulation kits, cycle tracking and cervical-mucus changes all help locate the window.
The study · 1
Wilcox 1995, N Engl J Med · N Engl J Med
Weight loss before treatment did not raise births, 27.1% versus 35.2%
Losing weight can restore ovulation in some women, but making a six-month weight-loss program a required first step before fertility treatment did not lead to more healthy births overall, mostly because of the delay it added. More women in the lifestyle group did conceive naturally.
The LIFEstyle trial randomized 577 obese infertile women (BMI 29 or higher) to a six-month lifestyle intervention before treatment or to prompt fertility treatment. The primary outcome, vaginal birth of a healthy singleton at term within 24 months, occurred in 27.1% of the lifestyle group versus 35.2% of the prompt-treatment group (rate ratio 0.77, 95% CI 0.60 to 0.99). Natural conceptions were more common in the lifestyle arm. The reading is nuanced: modest weight loss can restore ovulation and is worth pursuing, but mandating a lengthy program before treatment, and the delay that creates, did not improve the bottom line, which matters most when age is pressing.
If weight is affecting ovulation, modest weight loss is worth pursuing, but not as an open-ended precondition that delays treatment when time is short. It is a conversation to have with your clinician about your age and your specific cause.
The study · 1
Mutsaerts 2016, N Engl J Med · N Engl J Med
Acupuncture around IVF did not raise live births, 18.3% versus 17.8%
In the best trial, having acupuncture around IVF did not lead to more babies than a fake needle procedure. Chinese medicine is sought out for fertility a great deal, and on this specific question the evidence points to no gain in live births.
A 2018 multicenter randomized trial (JAMA) enrolled 848 women undergoing IVF at 16 sites in Australia and New Zealand, assigning them to acupuncture or a sham (non-insertive) needle control around the time of embryo transfer. Live births occurred in 18.3% of the acupuncture group and 17.8% of the sham group (risk ratio 1.02, 95% CI 0.76 to 1.38), with no significant difference in clinical pregnancy either. This is the largest and most rigorous trial on the question, and it found no benefit of acupuncture on IVF live-birth rates over sham. Stating this plainly is part of doing right by a vulnerable audience, even where Chinese medicine is most sought.
If acupuncture is something you find calming during a demanding treatment, that is a fair reason to have it; the evidence does not support it as a way to raise the live-birth rate from IVF, so it is best seen as support rather than a fertility treatment.
The study · 1
Smith 2018, JAMA · JAMA
Chinese herbal medicine tied to about double the pregnancy rate in low-quality trials
Pooled studies suggest Chinese herbal medicine may raise pregnancy rates for female infertility, but the trials are small and low quality, so the real effect is likely smaller and the result should be read as a signal to study, not a proven treatment.
A 2015 updated meta-analysis pooled randomized and non-randomized studies of Chinese herbal medicine for female infertility, reporting roughly a two-fold increase in pregnancy rates over 3 to 6 months compared with Western medical treatment. The authors themselves flagged serious limitations: many included studies were of low methodological quality, poorly randomized or non-randomized, mostly from a single region, and prone to publication bias, and pattern-based prescribing makes trials hard to standardize. The pooled figure should therefore be read as an early, low-certainty signal that warrants proper trials, not as evidence that a herbal formula can be relied on to achieve pregnancy.
If you wish to use Chinese herbal medicine, do so with a qualified practitioner who has assessed your pattern and alongside a full medical workup, understanding the evidence is early and low-certainty rather than a substitute for treatment matched to your cause.
The study · 1
Ried 2015, Complement Ther Med · Complement Ther Med
Antioxidants for men may raise live birth, on very low-certainty evidence
Antioxidant supplements for men might improve the chance of a live birth, but the studies behind that are few, small and low quality, so the benefit is very uncertain. This is a weak signal, not a reliable treatment.
A 2022 Cochrane review examined antioxidants (such as vitamin E, vitamin C, zinc, selenium, carnitine and coenzyme Q10) for subfertile men. It found antioxidants may improve live-birth and clinical-pregnancy rates compared with placebo or no treatment, but rated the certainty of evidence as low to very low because the trials were few, small, heterogeneous, at high risk of bias and inconsistently reported, with wide confidence intervals. The reviewers called for large, well-conducted trials before antioxidants can be recommended, and noted adverse effects were poorly reported. The takeaway is a weak, uncertain signal rather than an established benefit.
If a man wishes to try an antioxidant, it is low-cost and low-risk, but it should be understood as a weak, uncertain option, not a substitute for stopping smoking, avoiding heat, or having a male factor properly evaluated.
The study · 1
de Ligny 2022, Cochrane Database Syst Rev · Cochrane Database Syst Rev
Antioxidants for women showed no clear benefit for a live birth
For women, antioxidant supplements have not been shown to improve the chance of a live birth or pregnancy. The evidence is low quality, so this is uncertain, but there is no clear benefit to point to.
A 2020 Cochrane review of antioxidants for subfertile women pooled trials of agents including vitamin E, vitamin C, folic acid, myo-inositol, melatonin and N-acetylcysteine. It reported a low-certainty possible increase in live birth and clinical pregnancy (a signal since undermined by the retraction of seven included trials) rather than clear evidence of a difference in live-birth or clinical-pregnancy rates for antioxidants overall versus placebo, standard care or another antioxidant, and rated the evidence low to very low certainty because of poor reporting, imprecision and risk of bias. The reviewers concluded there was insufficient evidence to recommend any specific antioxidant. The result argues against relying on general fertility supplements for women, while leaving specific agents for defined conditions to a clinician.
General antioxidant fertility supplements are not a reliable route to conceiving for women; specific supplements for a defined condition, such as folic acid before pregnancy or agents in PCOS, are a separate matter to discuss with a clinician.
The study · 1
Showell 2020, Cochrane Database Syst Rev · Cochrane Database Syst Rev
Measurement And Diagnosis
Infertility rises with age, from about 8% of couples at 19 to 26 to about 18% at 35 to 39
The chance of conceiving in any given cycle drops as you get older, and it drops for both partners. Measured as the share of couples who stay infertile, it climbs from about 8% in the twenties to about 18% by the late thirties, with a smaller decline on the male side too.
In a study of 782 couples using natural family planning across seven European centers, with intercourse timed to the fertile window, the share of couples who remained infertile rose with the age of both partners: from about 8% at ages 19 to 26 to about 13 to 14% at 27 to 34 and about 18% at 35 to 39. An independent rise was linked to male partners aged 35 and over, climbing from about 18% to 28% between 35 and 40. Because intercourse timing was accounted for, the decline reflects biology rather than less frequent sex. It is population data: many older individuals conceive readily, and it describes averages, not any one person.
Who this may not transfer to:The decline was measured in both female and male partners within the same couples, so it applies to both sexes rather than one.
The study · 1
Dunson 2004, Obstet Gynecol · Obstet Gynecol
Male factor contributes to about half of couples who struggle
About half the time a couple struggles, there is something on the male side, on its own or together with a female factor. That is why a semen analysis belongs early in the workup, not after the woman has been fully investigated.
A 2021 Lancet seminar synthesizing the field states that male factors contribute to about half of all cases of couple infertility and are the sole cause in a substantial share. Semen analysis, assessing sperm concentration, motility and morphology against reference values, is the foundation of the male evaluation, with hormonal, genetic and imaging tests added when it is abnormal. Many male causes are treatable or bypassable with assisted reproduction, and some, such as smoking, heat and a varicocele, are modifiable. The clinical point is that evaluating both partners from the outset avoids the common error of working up the woman alone.
The study · 1
Agarwal 2021, Lancet · Lancet
Most couples conceive within a year of well-timed trying, 92% by twelve cycles
Given regular, well-timed sex, most couples conceive within a year: about 68% by three cycles, 81% by six and 92% by twelve. That is why a year of trying, or six months past thirty-five, is the usual point to seek help, and it is real grounds for hope early on.
A prospective German study followed 346 women who used natural family planning to time intercourse from their very first cycle of trying. The cumulative probability of conception rose to 38% after one cycle, 68% after three, 81% after six and 92% after twelve, and 36 women (10.4%) had not conceived within the study. The authors read this as most couples conceiving within about six well-timed cycles, with roughly half of those still trying beyond a year being subfertile or infertile, which is what makes twelve months, or six months past thirty-five, a sensible point to be evaluated rather than to keep waiting. Because these couples timed intercourse deliberately, the curve describes a near-best case of natural fertility rather than the average couple.
Who this may not transfer to:Conception is a couple outcome recorded through the women in the cohort, so it reflects both partners rather than the female side alone.
If you are having regular, well-timed sex, the yearly odds are with you at first; treat the twelve-month mark, or six months if the woman is over thirty-five, as the point to seek evaluation rather than a reason to worry sooner.
The study · 1
Gnoth 2003, Hum Reprod · Hum Reprod
Mood & stress
Emotional distress did not lower the chance of treatment success
Being anxious or low before fertility treatment does not make it fail. This matters because it lifts the unfair blame from women who are told they are not relaxed enough, while making clear the distress itself is real and deserves support.
A 2011 meta-analysis in the BMJ pooled 14 prospective studies (3583 women) measuring emotional distress before a cycle of assisted reproduction. Pre-treatment anxiety and depression were not associated with the chance of becoming pregnant (for example, no significant difference in distress between women who did and did not conceive). The authors concluded that emotional distress does not compromise the chance of ART success, which counters the common and harmful message that women simply need to relax. The distress of infertility and its treatment is nonetheless common and real, and deserves support in its own right, not as a means to an end.
The finding removes the blame in just relax, and it does not mean feelings do not matter: support for the strain of trying to conceive is worth seeking for your own wellbeing, independent of any effect on the odds.
The study · 1
Boivin 2011, BMJ · BMJ
What Does Not Help, and What To Stop Blaming
Knowing what does not move the odds saves money, spares false hope, and lifts blame that is not earned. None of these is a failing to have tried or believed.
Acupuncture around IVF is the clearest case, because Chinese medicine is sought out for fertility more than almost anything. In the largest and most rigorous trial, acupuncture during IVF did not raise live births over a sham needle, 18.3% against 17.8%. If you find acupuncture calming through a demanding treatment, that is a fair reason to have it, as support and not as a way to raise the live-birth rate.
Endometrial scratching, a paid IVF add-on that scratches the lining of the womb before a cycle, made no difference to the number of babies in a large trial, 26.1% in both groups. It stands for a wider pattern of IVF extras sold ahead of their evidence, and it is a reason to ask what randomized evidence an add-on rests on before paying for it.
Modest weight loss can restore ovulation when weight is affecting it, and that is worth pursuing. But making a six-month weight-loss program a required first step before fertility treatment did not raise the birth rate in the trial that tested it, 27.1% against 35.2% with prompt treatment, largely because of the delay it added, which costs the most when age is pressing. Pursue modest weight loss without letting it become an open-ended precondition that uses up time.
The heaviest blame to lift is the belief that stress causes infertility. Being anxious or low before fertility treatment does not make it fail: pooled across fourteen studies of 3,583 women, emotional distress before a cycle did not lower the chance of becoming pregnant.
Emotional distress does not cause infertility, and it does not lower the chance that treatment works.
This lifts the unfair message that women simply need to relax. The distress deserves support in its own right, not as a means to an end.
The modifiable harms are smoking and heavy drinking. Women who smoke are more likely to have trouble conceiving, by about 60% higher odds, and take longer to do so, and smoking also lowers sperm quality, so stopping helps on both sides. Heavier drinking, around fourteen or more drinks a week, is linked with taking longer to conceive, while lighter intake has not shown a clear effect, so cutting back matters most for heavier drinkers. Many people choose to avoid alcohol once actively trying, given the uncertainty in early pregnancy.
How It Works
Conception depends on an egg and sperm meeting in a narrow window, and each part of the workup checks one step in that sequence. Each cycle the ovary releases a single mature egg, which survives for about a day, while sperm can live several days in the reproductive tract. That mismatch is why the fertile window opens before ovulation and closes on the day itself, and why sex in the two or three days before ovulation carries the best odds.
The egg then has to travel down an open fallopian tube, meet enough well-moving sperm, and, once fertilized, implant in a receptive uterine lining. A problem at any step lowers the odds:
- absent or irregular ovulation, as in PCOS;
- blocked or damaged tubes, often from past pelvic infection, surgery, or endometriosis;
- too few or poorly moving sperm;
- or a combination of these.
This is why the standard workup checks ovulation, the tubes, and a semen analysis together: the fix depends on which step is involved.
Age acts on the supply and quality of eggs. A woman is born with all the eggs she will have, and both their number and their quality fall over time, gradually through the twenties and early thirties and faster afterward, which raises the chance of a cycle without a viable egg and of early miscarriage. A smaller, slower decline shows on the male side in sperm quality. This is the one factor no treatment fully reverses, which is why time itself is part of the picture and the reason the evaluation thresholds tighten with age.
Go Deeper
- Male fertility: the male half of the picture, what a semen analysis measures, and the levers a man can pull himself, since a male factor is about half of cases.
- Polycystic ovary syndrome: the most common ovulation problem behind infertility, and the daily habits, inositol, metformin, and letrozole that help it.
- Endometriosis: a common cause of pelvic disease and blocked tubes, and how its pain and its effect on fertility are treated.
- Perimenopause: the years of declining and irregular cycles that shape fertility as time grows short.
The Chinese Medicine View
The Chinese Medicine View
Chinese medicine has been sought out for fertility for centuries, and this is a central classical domain, not a modern add-on. It reads conception through the Kidneys, which store the essence (Jing) that governs reproduction and is slowly spent across a life, and through the balance of Kidney Yang and Kidney Yin. The Chong and Ren, two of the extraordinary vessels, fill the uterus and govern the cycle and conception, while the Liver moves the Qi and stores the Blood that build a rich lining. Read the patterns below as an interpretive lens a practitioner works with, informed by the pulse and tongue signs that a written page cannot assess, and not as a diagnosis or a promise. Two lenses sit here together. The tradition is evidence of what has helped people over a long time, and the modern trial picture is specific: the largest trials of acupuncture during IVF did not raise live births over a sham needle, and the Chinese-herbal-medicine evidence is emerging and of low quality. The strength of a tradition is not the same as a guarantee of effect, so Chinese medicine belongs alongside a full medical workup and, where needed, assisted reproduction, offered as support and not instead of the treatment that has the odds.
A cold, depleted picture: low back and knee weakness, cold limbs, low libido, a long cycle or scanty flow, and a sense of never quite warming through. The direction is to warm and supplement Kidney Yang, the reading behind formulas in the Er Xian Tang and You Gui family.
Depletion on the cooling, substantial side: night sweats, dryness, dizziness, a short or scanty cycle, and the diminishing reserve that Chinese medicine links to age. The direction is to nourish Yin and replenish essence rather than to force the system.
The pattern of constraint under strain: irritability, breast and rib-side distension before the period, cycles that vary, and the tension that trying month after month can bring. The direction is to soothe the Liver and move the Qi, the ground the Xiao Yao San family is built on.
Too little Blood to build a rich lining: a scanty, pale flow, dizziness, pallor, and fatigue. The direction is to tonify Blood and Qi so the uterus is nourished across the cycle, working through the Chong and Ren that fill it.
Common in the polycystic picture: weight that gathers, tiredness after eating, a heavy sluggish feeling, irregular or absent ovulation, and a swollen tongue with a greasy coat. The direction is to strengthen the Spleen and transform Phlegm-Damp.
Cautions
Extra restraintEverything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Smoking raised the odds of infertility by about 60%
A systematic review and meta-analysis pooled observational studies on smoking and female fertility. The odds of infertility were significantly higher in smokers than non-smokers (OR 1.60, 95% CI 1.34 to 1.91), and smokers took longer to conceive, with a higher proportion of delayed conception beyond a year. The evidence is observational, so residual confounding cannot be excluded, but the association is consistent and biologically plausible, and smoking is a reversible harm. Smoking also lowers sperm concentration and quality in men, so the case for stopping applies to both partners.Augood 1998, Hum Reprod
Seek evaluation after twelve months, or six past thirty-five
A committee opinion from the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine sets out that female fertility declines with age, gradually until the early thirties and more rapidly thereafter, and recommends earlier evaluation and treatment: after 12 months of trying for women under 35, but after 6 months for women aged 35 and older, and immediate assessment when there is a known risk factor such as irregular or absent cycles, a history of pelvic disease, or a suspected male factor. The aim is to avoid losing time that cannot be recovered, so that more options stay open.ACOG/ASRM Committee Opinion 589, 2014, Fertil Steril
Fourteen or more drinks a week lowered the monthly chance of conceiving
A prospective cohort of 6120 Danish women trying to conceive, followed with menstrual-cycle data, found fecundability was reduced among those consuming 14 or more servings of alcohol per week (fecundability ratio 0.82, 95% CI 0.60 to 1.12), with no clear reduction across categories of low-to-moderate intake below that threshold. The estimate for heavy intake was imprecise because relatively few women drank that much. The practical reading is that heavy drinking is worth reducing when trying to conceive, while an occasional drink has not been shown to matter; many clinicians still advise avoiding alcohol once actively trying, given uncertainty in early pregnancy.Mikkelsen 2016, BMJ
Do not let time slip when age is pressing
The thresholds below exist because age is the one factor no treatment fully reverses. If the woman is over thirty-five and you have tried for six months, or there are irregular cycles or a known problem, book an evaluation now. Earlier assessment keeps more options open.
Read fertility supplements for what they are
General fertility supplements and antioxidant blends are mostly low-cost and low-risk, but the outcome evidence is weak, and they are not a substitute for a semen analysis, treating a specific cause, or stopping smoking. Folic acid before conception is the one supplement that is standard care, and it protects the pregnancy; it does not raise the chance of conceiving.
Chinese herbs during treatment and pregnancy
If you use Chinese herbal medicine, do so with a qualified practitioner who has assessed your pattern and who knows you are trying to conceive or may already be pregnant, since some herbs are not suitable in pregnancy and some can interact with fertility medications. Source herbs from regulated suppliers who test their material, and keep your fertility clinician informed of anything you take.
Ask what an IVF add-on is proven to do
Extras sold on top of a standard IVF cycle vary widely in what evidence supports them, and endometrial scratching, one of the most common, made no difference to live births in a large trial. Before paying for any add-on, ask what randomized evidence shows it improves the chance of a baby.
Trying to conceive is not a medical condition to be fixed, and most of what helps is in the sections above. Consult a licensed clinician for an evaluation matched to your age and history, and promptly if any of the signs below fit you.
When to See Someone
Trying to conceive is not an emergency, and most of what helps is in the sections above. These are the signs to bring to a doctor or fertility specialist, and some of them are a reason to go sooner rather than to give it more time:
- A year of regular, unprotected sex without a pregnancy, which is the usual point to seek evaluation, so that a cause can be found and treated.
- Being over thirty-five and having tried for more than six months, or over forty and trying at all. Because fertility falls with age, evaluation is advised after six months past thirty-five rather than the twelve months for younger couples, so that time stays on your side.
- No periods, or cycles that are very irregular, very long, or very short, which usually points to an ovulation problem that is common, often treatable, and worth assessing early.
- Known or suspected tubal or pelvic disease: a past pelvic infection, pelvic surgery, an ectopic pregnancy, or severe endometriosis, which can block the tubes and is worth checking early.
- A very abnormal semen analysis, or a known problem on the male side such as an undescended testicle, prior chemotherapy or radiotherapy, or a testicular injury. A male factor is about half of cases, so this is a shared workup, not the woman alone.
- The emotional toll of trying: persistent low mood, anxiety, or strain that is hard to carry, and urgently any thoughts of harming yourself. This is common and treatable, support is available, and reaching for it is a strength.(seek urgent care)
None of this is meant to take away hope. Many couples conceive with time, with timing, or with the right treatment matched to the cause. The signs above get their own section because a few of them, age and the treatable blocks especially, are the ones where acting sooner keeps the most options open for you.
Common Questions
How long does it take most couples to conceive?
Most conceive within a year of regular, well-timed sex. In a prospective study of couples timing intercourse from their first cycle, cumulative conception reached 38% after one cycle, 68% by three, 81% by six, and 92% by twelve (Gnoth, Hum Reprod 2003). That is why a year of trying, or six months past thirty-five, is the usual point to seek evaluation, and it is grounds for hope early on.
When should we get evaluated for infertility?
After twelve months of trying for couples where the woman is under thirty-five, and after six months if she is thirty-five or older, because waiting costs more when time is short (ACOG/ASRM Committee Opinion 589, Fertil Steril 2014). Go sooner with irregular or absent cycles, known pelvic disease, or a suspected male factor. Earlier assessment keeps more options open.
Is infertility usually the woman's problem?
No. A male factor is involved in about half of couples who struggle, on its own or alongside a female cause, which is why a semen analysis belongs early in the workup (Agarwal, Lancet 2021). Roughly a third of cases trace mainly to the woman, a third mainly to the man, and the rest to both or to no cause testing can find. Working up both partners from the start avoids the common error of investigating the woman alone.
Does acupuncture improve the chance of IVF working?
Not for live births, on the best evidence. In the largest trial, 848 women undergoing IVF, acupuncture around the procedure gave a live-birth rate of 18.3% against 17.8% with a sham needle, with no meaningful difference (Smith, JAMA 2018). If acupuncture helps you feel steadier through a hard treatment, that is a fair reason to have it, as support and not as a way to raise the odds of a baby.
Do fertility supplements help you conceive?
Mostly not in a reliable way. For women, general antioxidant supplements have not been shown to improve live birth, and the review reporting a possible benefit has since had several trials retracted (Showell, Cochrane 2020). For men the signal is weak and very uncertain (de Ligny, Cochrane 2022). Folic acid before conception is the exception that is standard care, and it protects the pregnancy against neural-tube defects; it does not raise fertility (MRC Vitamin Study, Lancet 1991).
Can stress or not relaxing cause infertility?
No. Pooled across fourteen studies of 3,583 women, emotional distress before a cycle of treatment did not lower the chance of becoming pregnant (Boivin, BMJ 2011). Being told to just relax carries a blame that is not earned. The distress of trying to conceive deserves support in its own right, separate from any effect on the odds.
Does losing weight before treatment lead to more babies?
Modest weight loss can restore ovulation when weight is affecting it, but requiring a six-month weight-loss program before treatment did not raise the birth rate: 27.1% against 35.2% with prompt treatment, largely because of the delay it added (Mutsaerts, N Engl J Med 2016). Pursue modest weight loss without letting it become an open-ended precondition that uses up time you may not have.
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All 16 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
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