When should the initial infertility evaluation be started?

• A. If trying for more than 12 months (or more than 6 months if age ≥35), evaluate both partners; confirm ovulation; assess tubal patency; perform semen analysis; ovarian reserve testing; pelvic ultrasound; review medical history.
• B. After 2 years of trying.
• C. Only after confirming pregnancy.
• D. After 6 months regardless of age.

Answer: (A)

The main idea here is when to start the infertility workup based on how long a couple has been trying and the woman’s age. The standard threshold is after 12 months of trying to conceive if she is under 35, or after 6 months if she is 35 or older. Age matters because fertility can decline more quickly once you reach mid‑30s, so starting evaluation earlier can catch problems sooner and improve outcomes.

A comprehensive initial assessment should involve both partners. In the woman, confirm that ovulation is occurring; in the couple, assess tubal patency; perform a semen analysis for the male factor; evaluate ovarian reserve; obtain pelvic ultrasound to look for structural issues; and review medical and reproductive history for conditions like endometriosis, prior pelvic infections, surgeries, or other risk factors. This broad approach helps identify common, treatable causes such as irregular ovulation, blocked Fallopian tubes, male-factor infertility, diminished ovarian reserve, or uterine/adnexal abnormalities, guiding appropriate next steps.

Choosing a later start, like 2 years, would delay potential treatments; starting after 6 months for everyone ignores the impact of age on fertility; and waiting until pregnancy is not a workup at all.