“Not every delay in conceiving calls for IVF. In some cases, however, waiting too long can steadily narrow the window for fertility treatment.”
When the journey towards a baby lasts longer than expected, many couples begin to ask: When should we have IVF? Should we try IUI first? Or should we keep waiting for a natural pregnancy?
In reality, in vitro fertilisation (IVF) is not the first choice for every case of infertility. Depending on the cause, the woman's age, how long the couple has been trying, ovarian reserve and sperm quality, the doctor may suggest natural monitoring, ovulation-induction medication, IUI or IVF.
However, there are cases in which assessment and fertility counselling should not be delayed, because time can directly affect the chance of becoming pregnant.
What is IVF (in vitro fertilisation)?
🧬 IVF – In Vitro Fertilization is an assisted reproduction method in which eggs are retrieved from the ovaries and combined with sperm in the laboratory to create embryos. A suitable embryo is then transferred into the uterus to carry on developing.
According to the CDC, IVF is the most common form of assisted reproductive technology (ART) – techniques in which eggs or embryos are handled directly outside the body.
IVF may be recommended straight away in some cases, or considered after less invasive methods have failed to work.
When should you see a doctor about infertility?
You do not necessarily have to wait several years before being assessed.
According to the American Society for Reproductive Medicine (ASRM):
✔️ Women under 35: should have their fertility assessed after 12 months of regular intercourse without contraception and no pregnancy.
✔️ Women aged 35 and over: should be assessed after about 6 months without a pregnancy.
✔️ Women over 40: may need to be assessed and treated sooner, even right from the start.
In addition, if you already know that you or your partner has a factor that may affect fertility, such as blocked fallopian tubes, endometriosis, irregular periods or a sperm problem, then there is no need to wait the full 6–12 months before being assessed.
7 situations that call for an early assessment and IVF advice
1. The wife is 35 or older and conception is delayed
👩 A woman's age is one of the most important factors affecting fertility.
According to ASRM, a woman's fertility declines gradually with age, and the decline becomes more marked as she gets older. Age also affects the response to fertility treatment and the likelihood of IVF success.
So:
- Under 35: be assessed if you have been trying for ≥12 months.
- From 35: be assessed if you have been trying for ≥6 months.
- Over 40: take the initiative and see a doctor early rather than carrying on waiting for a long time.
Mayo Clinic also notes that IVF can sometimes be considered as a primary treatment in people over 40, depending on their specific fertility situation.
The key point: 35 is not the “age at which IVF becomes compulsory”. It is the point at which to shorten the waiting time before fertility is assessed.
2. Blocked or damaged fallopian tubes
🥚 In natural conception, the egg and sperm usually meet in the fallopian tube before the embryo travels to the uterus.
If both fallopian tubes are blocked or severely damaged, this process can be obstructed.
Possible related causes include:
- Pelvic inflammatory disease
- A previous genital tract infection
- Endometriosis
- Pelvic adhesions after surgery
- Damage to the fallopian tubes
- Previous tubal ligation
IVF can bypass the role of the fallopian tubes, because fertilisation takes place outside the body before the embryo is placed in the uterus.
Mayo Clinic lists damaged or blocked fallopian tubes as one of the conditions for which IVF may be considered.
3. The man has significantly abnormal sperm
👨⚕️ Infertility does not come only from the woman's side.
Some problems commonly picked up on a semen analysis include:
- A low sperm count
- Poor motility
- A high proportion of abnormally shaped sperm
- Declining sperm quality
- No sperm found in the semen in some cases
If the sperm abnormality is significant, the doctor may consider IVF combined with ICSI – intracytoplasmic sperm injection.
In ICSI, a single sperm is injected directly into a mature egg to assist fertilisation. The CDC states that this technique is commonly used in cases involving a male infertility factor.
However, not every abnormal semen analysis requires IVF. Men still need to be assessed by a doctor to identify the cause and to see whether another treatment option would be more suitable.
4. Endometriosis affecting fertility
🌸 Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus.
This condition can affect:
- The ovaries
- The fallopian tubes
- Pelvic structures
- The meeting of egg and sperm
- The ability of the embryo to implant
Endometriosis can also create scar tissue or pelvic adhesions, which in turn makes conception more difficult.
However, endometriosis does not mean IVF is needed straight away.
In younger women with mild disease, the doctor may still consider monitoring, medical treatment or IUI in some cases. With severe disease, older reproductive age, a long history of infertility or previous methods that have failed, IVF may be considered sooner.
5. Unexplained infertility
❓ Some couples complete the basic assessments and still cannot pin down why pregnancy has not happened.
This is usually called unexplained infertility.
Initial assessments usually look at:
- Ovulation
- The structure and patency of the fallopian tubes
- The condition of the uterus
- The husband's semen analysis
If no clear cause is found, the doctor will consider a treatment approach based on age and how long the infertility has lasted.
Importantly, IVF is not necessarily the first treatment for every case of unexplained infertility.
ASRM states that in women under 38, current evidence does not support using IVF from the outset in place of some less invasive strategies. One approach often considered is ovarian stimulation combined with IUI for a number of cycles, moving on to IVF if it is not successful.
6. Ovulation disorders or reduced ovarian reserve
⚠️ When eggs are not released regularly or the number of remaining follicles has fallen, the chance of natural pregnancy can be affected.
Related conditions include:
- Polycystic ovary syndrome (PCOS)
- Endocrine disorders that stop ovulation
- Infrequent periods or absent periods
- Reduced ovarian reserve
- Declining ovarian function
Mayo Clinic identifies ovulation disorders as one of the common causes of female infertility.
But do bear in mind:
PCOS does not automatically mean IVF.
Many women with PCOS can still become pregnant after lifestyle changes, hormonal treatment or ovulation-induction medication. IVF is usually only considered when suitable earlier options have not worked or when other infertility factors are also present.
Similarly, a low AMH test result cannot on its own decide whether someone needs IVF. ASRM notes that ovarian reserve markers are used to help guide treatment and should not be used on their own to draw conclusions about fertility.
7. The wife or husband carries a genetic condition or variant requiring embryo screening
🧬 Some couples may carry gene variants linked to an inherited condition and worry about passing it on to their child.
Possible examples:
- Thalassaemia
- Certain single-gene inherited disorders
- Certain structural chromosome abnormalities
- A family history of an inherited disease with an identified cause
In suitable cases, IVF can be combined with preimplantation genetic testing (PGT).
The IVF process creates embryos in the laboratory. A few cells from an embryo can then be taken for testing, to help the doctor select a suitable embryo according to the genetic indication before embryo transfer.
The CDC confirms that preimplantation genetic testing can be carried out during assisted reproduction to identify certain genetic or chromosomal abnormalities in an embryo. ASRM also notes that couples carrying a genetic factor may need a fertility assessment before PGT is performed.
PGT does not guarantee that a baby will be entirely free of every condition, and the decision to test needs specific counselling from a fertility specialist together with a genetics expert.
Is IVF the first choice when conceiving is difficult?
Not always.
📌 Depending on the cause, the doctor may consider:
Monitoring & intercourse timed around ovulation
↓
Treating the underlying cause or inducing ovulation
↓
Intrauterine insemination (IUI)
↓
In vitro fertilisation (IVF/IVF-ICSI)
However, this order is not applied rigidly to everyone.
For example, someone with both fallopian tubes severely blocked, a serious sperm factor, advanced reproductive age or a need for PGT may be advised to move to IVF early rather than spending a long time on methods with a low chance of success.
The CDC also stresses that the choice of infertility treatment depends on the cause, how long the infertility has lasted, age, test results and the wishes of the person being treated.
What does an infertility assessment before IVF usually check?
🔬 Before deciding whether IVF is needed, both partners usually need a fertility assessment.
Depending on the case, the doctor may order:
For women
- A history of the menstrual cycle and previous pregnancies
- Gynaecological ultrasound
- Assessment of ovulation
- Ovarian reserve tests such as AMH or AFC where appropriate
- Examination of the uterus
- Assessment of tubal patency
- Certain hormone tests as indicated
For men
- A reproductive history
- Semen analysis
- An andrology examination where needed
- Hormone tests or further tests if indicated
ASRM recommends that when a male partner is involved in trying for a pregnancy, the fertility of both partners should be assessed in parallel, rather than focusing only on testing the woman.
Do not wait until there is “no other option” before seeking IVF advice
💙 One fairly common belief goes:
“Let's keep trying naturally for a while longer and only think about IVF if it does not work.”
This may be reasonable for some young couples with no risk factors. But for those aged 35 and over, or who already have a condition affecting fertility, delaying too long can reduce the treatment options available.
Being assessed for infertility early does not mean that you will have to have IVF.
The aim of the first appointment is to work out why pregnancy has not happened and which method is the most suitable at this point in time.
IVF is only one of the options.
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✔️ Explore and compare fertility programmes at partner hospitals and clinics
✔️ Book an infertility appointment and IVF consultation conveniently
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✔️ Manage health records for the whole family
The journey towards a baby is not the same for every family. Identifying the cause correctly and choosing the right moment can matter just as much as choosing the treatment method.
References
📚 American Society for Reproductive Medicine (ASRM) – Fertility Evaluation of Infertile Women
📚 American Society for Reproductive Medicine (ASRM) – Evidence-based Treatments for Couples with Unexplained Infertility
📚 Centers for Disease Control and Prevention (CDC) – Infertility: Frequently Asked Questions
📚 Centers for Disease Control and Prevention (CDC) – Assisted Reproductive Technology
📚 Mayo Clinic – In Vitro Fertilization (IVF)
📚 Mayo Clinic – Infertility: Symptoms and Causes
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