What counts as infertility?

The clinical definition

ASRM defines infertility as the failure to achieve pregnancy after 12 months of regular, unprotected intercourse for people under 35, or after 6 months for people 35 and older. The shorter window for people over 35 reflects the steeper age-related decline in egg quantity and quality.

In 2023, ASRM expanded the definition to explicitly include people who need medical intervention to conceive — for example, single people and same-sex couples — even without a 'failed' trial period. This matters because insurance plans that cover 'infertility' have historically excluded these groups; the updated definition is meant to push payers and state mandates toward inclusivity.

When the timeline doesn't apply

Some situations warrant a workup right away regardless of age or how long you've been trying: irregular or absent periods, a history of pelvic infection or endometriosis, prior pelvic or abdominal surgery, two or more miscarriages, a known male-factor diagnosis, or any condition that affects ovulation (like PCOS or thyroid disease).

If any of these apply, ask your OB/GYN for a referral to a reproductive endocrinologist now — don't wait out the 6 or 12 months.

Primary vs secondary infertility

Primary infertility means you've never had a pregnancy. Secondary infertility means you've had at least one pregnancy before but are now struggling to conceive again. Secondary infertility is often emotionally underestimated by friends and family ('but you already have one!') even though the medical workup and treatment options are the same.