Infertility is not an uncommon problem seen in the primary care setting; as many as 10-15 percent of couples in the U.S. are infertile, which is defined as the inability to conceive after a year of frequent unprotected sex.
The first step in evaluation of an infertile couple is education regarding the ovulatory cycle of the woman and the optimal timing of intercourse to increase chances of fertilization. This involves review of the fact that ovulation typically occurs 14 days after the start of a woman's menstrual cycle, and that the couple should focus on having intercourse in the days around ovulation. In terms of factors contributing to infertility, men and women contribute at around equal rates. For men, sperm analysis can be conducted to check sperm count and motility. For women, tests can be done to ensure that ovulation is actually occurring on a monthly basis, and imaging with ultrasound
may be conducted to evaluate the uterus and fallopian tubes. In about one-third of cases of infertility, no cause is found. However, even in these circumstances, treatments for infertility may be possible.
You should talk to your primary care doctor
about your difficulty conceiving, and your doctor can start a basic work-up and refer you to a reproductive endocrinology
expert for further testing.