What are the signs that might mean you need a fertility review?

4 March 2025

Dr Montse Amodeo

What are the signs that might mean you need a fertility review?

Embarking on the journey to start or grow your family is an exciting and deeply personal decision. However, for many individuals and couples, this time can also bring questions, concerns, and sometimes unexpected challenges.

It’s important to remember that seeking a fertility review is not a sign of failure; it’s an empowering step towards understanding your reproductive health and giving yourself options for future family building.

We asked Dr Montse Amodeo, gynaecologist and fertility specialist at The Evewell West London, to explain the red flags and signs that may mean you need to consider a fertility review.

How long does it usually take to get pregnant?

As a fertility specialist and a mother, I understand the TTC journey and how overwhelming it can feel to consider seeking help, especially at the very start of your fertility journey.

One of the most common questions I hear is, “How long should it take to conceive?” On average, most couples conceive within six to twelve months of trying, with regular, unprotected intercourse.

For women under 35, we generally recommend seeking advice after one year of trying. However, if you’re over 35, it’s wise to consult a specialist after six months due to the natural decline in fertility with age.

Remember, every individual and couple is different. If you feel unsure or anxious about your progress, there’s no harm in seeking a review sooner. Sometimes, even a simple discussion with a specialist can provide clarity and reassurance.

Recognising the signs: irregular or absent periods

Your menstrual cycle is a window that gives fertility specialists an insight into your reproductive health. Regular cycles, occurring every 21–35 days, generally indicate consistent ovulation, essential for conception.

If your cycles are irregular, unusually long, or absent altogether, it could signal an underlying issue such as:

• Polycystic Ovary Syndrome (PCOS): A common condition affecting ovulation
• Thyroid disorders: Imbalances in thyroid hormones can disrupt your cycle
• Premature Ovarian Insufficiency (POI): A condition where ovarian function declines earlier than expected

Even if your cycle seems “normal,” subtle irregularities can sometimes signify hormonal imbalances. If you’re unsure, it’s always better to check.

Addressing known reproductive or medical conditions

If you already have a diagnosed condition that might affect fertility, such as endometriosis, PCOS, or a history of pelvic infections, it’s a good idea to have a fertility review early in your journey.

For many women, living with endometriosis can feel like a lifelong battle – especially if symptoms have been normalised within their family or dismissed by healthcare professionals. It’s not uncommon for women to endure debilitating pain, heavy periods, or discomfort, believing it’s just part of being a woman because their mothers or grandmothers experienced the same.

Others may have sought help, only to have their concerns overlooked or misunderstood. If this resonates with you, it’s essential to know that these are not “normal” symptoms, and they could affect your ability to conceive.

Seeking a specialist evaluation can provide clarity, support, and access to effective treatment options, giving you the best chance of achieving your dreams of starting a family.

Similarly, if you’ve undergone treatments like chemotherapy or have conditions such as diabetes, you may want to explore how these factors could impact your fertility. Taking a proactive approach can help identify the best path forward.

Previous pregnancy complications

A fertility review isn’t just for those who haven’t conceived before. If you’ve experienced previous pregnancy complications, such as miscarriage, ectopic pregnancy, or difficulty conceiving a second child (known as secondary infertility), it’s essential to understand why.

These experiences can provide valuable insights into your reproductive health, and a tailored review can help address any underlying concerns, offering a more straightforward route to growing your family.

The impact of lifestyle factors

Modern lifestyles can inadvertently affect fertility. Factors such as high stress levels, poor nutrition, or insufficient sleep can play a role. Additionally, smoking, vaping, taking steroids or recreational drugs, excessive alcohol consumption, and being underweight or overweight can impact hormonal balance and reproductive function.

While lifestyle factors aren’t always the primary cause of fertility issues, addressing them can significantly improve your chances of conceiving.

During a fertility review, we consider these aspects to provide holistic advice tailored to your situation. We will recommend changes to your lifestyle that may allow you to conceive naturally without the need for invasive treatment.

Male factor infertility

Fertility reviews aren’t just for women. Male factor infertility accounts for nearly half of all infertility cases. Sperm health – encompassing count, motility, and morphology – can be influenced by genetics, lifestyle, or medical conditions.

Ensuring that both partners are assessed is essential for a comprehensive understanding of your fertility if you’re in a heterosexual partnership.

The role of intuition and emotional well-being

Sometimes, seeking a fertility review isn’t based on specific symptoms or guidelines but intuition. You might feel that something isn’t quite right or have a sense that you want to better understand your body before trying to conceive. Trusting these feelings is valid and important.

Equally, the emotional toll of trying to conceive can be significant. If you feel anxious, stressed, or overwhelmed, seeking a review can provide much-needed clarity and direction. Knowing where you stand can often alleviate uncertainty and help you feel more in control.

What to expect during a fertility review

A fertility review is a personalised, supportive process designed to identify any factors affecting your ability to conceive. At The Evewell, we prioritise empathy and understanding, creating a safe space where you can share your concerns and goals.

We offer female reviews, heterosexual couple reviews and same-sex couple fertility reviews, typically including:

• A detailed discussion of your medical and reproductive history
• AMH and TSH blood tests to evaluate hormonal levels and ovarian reserve
• Ultrasound scans to assess ovarian and uterine health
• And if you’re having treatment with a male partner, they’ll need a semen analysis to evaluate sperm health

These tests allow us to build a clear picture of your fertility and recommend the most appropriate next steps, whether that’s lifestyle adjustments, medical treatments, or assisted reproduction.

Taking the next step

At The Evewell, we’re here to support you with expertise, compassion, and personalised care.

Deciding to seek a fertility review is a courageous and proactive choice. Whether you’re just starting your journey or have been trying for some time, knowing more about your reproductive health can empower you to make informed decisions.

Contact our Patient Services team today to book your fertility review.

Note: This blog post is for informational purposes only and should not be considered medical advice. For personalised guidance, please consult with a doctor or fertility specialist.