The General Guidelines for Conception

For most healthy couples, conception typically occurs within a year of trying. This is based on the natural probability of pregnancy, which hovers around 20-25% per cycle for a couple in their prime reproductive years. While this statistic might seem low, it’s important to remember that even under ideal conditions, conception can take time.

According to medical guidelines, couples under the age of 35 are generally advised to try to conceive for at least 12 months (as women under 35 have higher fecundability) before seeking medical intervention, including a semen analysis. This timeframe allows for natural variability in fertility and ovulation cycles, giving the body time to adjust to the conception process.

However, for couples where the woman is over 35, the timeline shifts to 6 months of trying before considering fertility evaluations. Age is a significant factor in fertility for both men and women, with fertility naturally declining as people age. After 6 months, it is recommended to consult with a healthcare provider to explore potential concerns, including male fertility factors that might warrant a semen analysis.

Some Stats

• About 30% of couples conceive within the first month of trying.
• Approximately 60-75% conceive within 6 months.
• Around 80-90% conceive within 1 year.
• Up to 95% conceive within 2 years.

A study using a fertility awareness-based mobile application found:

• 61% cumulative pregnancy probability at 6 cycles
• 74% cumulative pregnancy probability at 12 cycles

It’s important to keep in mind that these guidelines are general and don’t account for individual medical histories or risk factors. Couples with known reproductive health issues, irregular cycles, or previous fertility challenges may need to seek a semen analysis or other fertility evaluations sooner. Additionally, any couple feeling concerned about their conception journey, regardless of timeline, should feel empowered to seek advice from a healthcare professional.

Factors That Affect Conception Timeline

While general guidelines provide a helpful baseline, a couple’s individual circumstances can significantly impact how long it takes to conceive. Several key factors influence the conception timeline, and understanding them can help couples better assess their fertility journey.

1. Age and Fertility
   Age is one of the most influential factors when it comes to fertility. In women, fertility typically begins to decline around age 30, with a sharper decrease after 35. Men’s fertility also decreases with age, though more gradually. Sperm quality, including count, motility, and morphology, can decline in men as they get older, potentially affecting conception. Couples in their mid-30s or older may need to consider a semen analysis earlier if conception isn't occurring as expected.
2. Lifestyle Factors
   Certain lifestyle choices can impact fertility for both men and women. Smoking, excessive alcohol consumption, poor diet, and lack of exercise can all decrease the likelihood of conception. For men, factors such as excessive heat (from tight clothing or frequent use of saunas/hot tubs), exposure to environmental toxins, and chronic stress can affect sperm quality. Making positive lifestyle changes—such as maintaining a healthy weight, reducing alcohol intake, quitting smoking, and managing stress—can improve fertility outcomes.
3. Frequency of Intercourse and Timing
   Another critical factor in the conception process is the timing and frequency of intercourse. Couples should aim to have regular intercourse during the woman’s fertile window, which typically occurs five days before and the day of ovulation (with the day of ovulation having the highest probability ~ 33%). Tracking ovulation through methods like basal body temperature, ovulation predictor kits, or fertility apps can help couples better time intercourse to maximize their chances of conception. Infrequent or poorly timed intercourse may lead to delays in conception.
4. General Health and Reproductive History
   Underlying health conditions, such as polycystic ovary syndrome (PCOS), endometriosis, thyroid issues, or diabetes, can influence fertility. For men, conditions like varicocele, infections, or hormonal imbalances can impact sperm production and quality. Additionally, a history of sexually transmitted infections (STIs) may have long-term effects on reproductive health. Couples with known health concerns or reproductive issues should consult a healthcare provider early in their journey to assess any potential impact on conception.
5. Past Fertility Experiences
   Couples who have experienced previous challenges in conceiving, recurrent miscarriages, or unsuccessful fertility treatments may need to consider more proactive fertility evaluations, including a semen analysis. A history of difficulty conceiving could suggest underlying issues with sperm quality or other reproductive factors that require attention.

Signs to Look Out For Early On

In some cases, a semen analysis may be considered sooner than the recommended timeframes, especially if there are red flags in the man’s reproductive health history. Couples may want to consider earlier testing if the male partner has a history of:

• Undescended testicles
• Previous testicular trauma or surgery
• Varicocele (enlarged veins in the scrotum)
• Sexually transmitted infections (STIs)
• Chemotherapy or radiation treatments
• Known hormonal imbalances
• Chronic conditions such as diabetes or thyroid disorders

Any of these factors could potentially impact sperm production or quality, making an early semen analysis a proactive step in identifying and addressing fertility issues.

• Lifestyle Factors That May Impact Fertility
  Lifestyle habits such as smoking, heavy alcohol consumption, drug use, or exposure to environmental toxins (e.g., pesticides, heavy metals) can negatively affect sperm health. If the male partner has a history of these habits, or if recent lifestyle changes haven’t led to improvements in conception success, it may be worthwhile to have a semen analysis to assess if sperm health is playing a role.
• Unexplained Delays in Conception
  For couples who are generally healthy and have been timing intercourse correctly but still aren’t seeing results, a semen analysis can help rule out male factor infertility as a contributing issue. Approximately 30-50% of infertility cases are linked to male factors, so ensuring both partners are evaluated can prevent unnecessary delays in finding a solution. Even if there is no known history of reproductive issues, unexplained delays in conception warrant a closer look at sperm health.
• Proactive Decision-Making
  Some couples may choose to pursue a semen analysis proactively, even before reaching the 6 or 12-month mark, as part of a comprehensive fertility evaluation. This can provide peace of mind or reveal areas that need attention before more time is spent trying to conceive without success.

Ultimately, the decision to pursue a semen analysis depends on each couple’s unique situation. For some, following the general timelines will suffice, while others may benefit from earlier testing based on health history or lifestyle factors. Either way, a semen analysis can provide valuable information that guides the next steps in the fertility journey, whether it leads to simple lifestyle adjustments or more advanced interventions.

What to Expect During a Semen Analysis

For couples considering a semen analysis, understanding what the process entails can help alleviate any concerns or uncertainties. This straightforward test provides essential insights into a man’s fertility by evaluating the health and function of sperm. Here's what to expect during the process:

1. Preparing for the Test
   Before the semen analysis, men are typically advised to abstain from ejaculation for 2 to 5 days to ensure the sample provides an accurate representation of sperm quality. Avoiding alcohol, smoking, and exposure to heat (like hot tubs) in the days leading up to the test may also be recommended to prevent any negative impact on the sample.
2. The Collection Process
   The semen sample is usually collected at a fertility clinic or a lab. Most often, the sample is produced through masturbation in a private room at the facility. Some labs may allow samples to be collected at home and delivered to the lab within a certain timeframe (usually within an hour), though specific instructions must be followed to ensure the sample is not damaged. In cases where masturbation is not an option, collection during intercourse using a special condom may also be a possibility.
3. What the Analysis Measures
   Once the sample is collected, it undergoes a series of tests to evaluate the following parameters:
   1. Sperm Count: The concentration of sperm in the semen. A normal range is typically 15 million sperm per milliliter or more.
   2. Sperm Motility: The ability of sperm to move efficiently. At least 40% of sperm should exhibit normal movement for optimal fertility.
   3. Sperm Morphology: The shape and structure of sperm. Abnormalities in sperm shape can reduce fertility, so the percentage of normally shaped sperm is measured.
   4. Volume and Liquefaction: The volume of the semen sample and how quickly it liquefies after ejaculation are also analyzed. A low volume may indicate an issue with seminal vesicles or the prostate.
4. Interpreting the Results
   After the analysis, the results are typically reviewed by a fertility specialist. If the sperm count, motility, or morphology falls below normal ranges, this may indicate potential fertility issues. However, a single abnormal result doesn't automatically mean that conception will be difficult—sperm quality can vary over time, and some men with less-than-ideal semen parameters are still able to conceive naturally. Your doctor will review the results and recommend next steps based on your specific situation.
5. Possible Outcomes and Next Steps
   Depending on the results of the semen analysis, there are several potential outcomes:
   1. Normal Results: If the analysis shows normal sperm parameters, the issue may lie elsewhere, and the couple may be advised to explore other fertility evaluations, such as ovulation testing or a hysterosalpingogram (HSG) to assess the woman’s fallopian tubes.
   2. Mild Abnormalities: If the results show mild abnormalities, lifestyle modifications such as improving diet, reducing stress, or avoiding environmental toxins may be recommended to improve sperm quality. Repeating the test after 2-3 months may also be suggested.
   3. Significant Abnormalities: If the results show significant sperm issues, further diagnostic testing may be needed to determine the underlying cause. Treatment options could range from medication to correct hormonal imbalances to assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF).

A semen analysis is a critical first step in diagnosing male infertility, but it’s important to remember that it is only one piece of the puzzle. For some couples, this test may lead to simple lifestyle changes, while others may require more advanced interventions. Either way, it provides valuable insight into the fertility journey and can help guide the next steps.

Working with Healthcare Providers

When fertility challenges arise, working closely with healthcare providers is key to ensuring that both partners receive appropriate evaluations and guidance. Fertility is a complex issue that often requires a holistic approach, and understanding the role of different healthcare professionals can help couples make informed decisions about their next steps.

1. The Role of OB-GYNs in the Fertility Journey
   For most couples, the first step in addressing fertility concerns is consulting with an OB-GYN. These specialists are well-versed in reproductive health and can offer initial guidance on the fertility process. OB-GYNs can recommend lifestyle changes, perform initial fertility evaluations (such as hormone testing or ovulation tracking for women), and help identify when it may be time to pursue more specialized testing, like a semen analysis for the male partner. Often, OB-GYNs serve as the primary point of contact for both partners during the early stages of trying to conceive.
2. Fertility Specialists and Urologists
   If conception isn’t occurring after a reasonable period of time, an OB-GYN may refer the couple to a fertility specialist, also known as a reproductive endocrinologist. These doctors are experts in fertility issues and can conduct more advanced tests, including in-depth semen analyses, hormone testing, and imaging studies to evaluate both male and female fertility. For men, a referral to a urologist specializing in male reproductive health may be necessary. Urologists can diagnose and treat conditions like varicocele, hormonal imbalances, or blockages that may be impacting sperm production or delivery.
3. Importance of Both Partners Being Evaluated
   Fertility is not solely a female issue—male factor infertility is responsible for about 30-50% of infertility cases. For this reason, it’s crucial that both partners are evaluated early in the process. While women may undergo hormone testing, pelvic exams, and ovulation monitoring, men should have their sperm analyzed to rule out potential issues. By ensuring that both partners are evaluated, couples can avoid unnecessary delays in diagnosis and treatment.
4. Open Communication with Healthcare Providers
   Communication is essential when working with healthcare providers. Couples should feel comfortable discussing any concerns, questions, or anxieties they have about the fertility process. Being open about medical history, lifestyle habits, and the emotional impact of fertility challenges can help healthcare providers offer more tailored advice. It’s also important to ask questions about the timing of interventions, the significance of test results, and potential treatment options to fully understand the path forward.
5. When to Discuss Fertility Testing
   The right time to discuss fertility testing varies from couple to couple, but general guidelines suggest consulting a healthcare provider if conception hasn’t occurred after 12 months of trying for couples under 35, or 6 months for couples over 35. However, couples who have known reproductive issues, irregular menstrual cycles, or other risk factors should seek advice earlier. By initiating conversations about fertility testing with a healthcare provider, couples can ensure that any underlying issues are identified and addressed promptly.
6. Navigating the Emotional Aspect of Fertility Testing
   Undergoing fertility testing can be emotionally challenging for both partners. Feelings of stress, anxiety, or even guilt may arise, particularly if tests reveal abnormal results. It’s important for couples to seek emotional support during this time, whether through counseling, support groups, or open conversations with each other. Healthcare providers can often recommend resources to help couples cope with the emotional aspects of fertility testing and treatment.

By working closely with OB-GYNs, fertility specialists, and urologists, couples can navigate the fertility testing process with confidence. These healthcare providers offer the expertise needed to diagnose potential issues and recommend effective treatments, helping couples move closer to their goal of conception.

Addressing Common Concerns

The fertility journey can bring up many questions and concerns for couples, particularly when facing the prospect of fertility testing like semen analysis. Addressing these common concerns openly can help reduce anxiety, clarify misconceptions, and encourage more productive conversations between partners and healthcare providers.

Emotional and Psychological Aspects of Fertility Testing
For many couples, fertility testing can be an emotionally charged process. It’s not uncommon for couples to feel stress, frustration, or even guilt, especially if testing reveals fertility issues. Men, in particular, may feel stigmatized or embarrassed about undergoing a semen analysis. It’s important to remember that fertility challenges are a shared issue and that testing provides valuable information to help both partners move forward. Seeking support from therapists, fertility counselors, or support groups can help couples navigate the emotional aspects of testing and treatment.

Overcoming the Stigma of Male Fertility Testing
Historically, fertility has often been perceived as a "female issue," but male fertility is equally important. Around 50% of infertility cases involve male factors, yet there is still a lingering stigma that can make men hesitant to undergo testing. Open communication between partners can help normalize the process and reinforce the understanding that fertility challenges affect both individuals. Additionally, more public awareness about the role of male fertility and the importance of semen analysis can help reduce the stigma over time.

Dispelling Myths About Male Fertility
Many myths persist around male fertility, which can lead to misunderstandings about when and why a semen analysis is necessary. Common misconceptions include beliefs that fertility automatically declines after a certain age in all men or that sperm health is solely determined by lifestyle factors. While age and lifestyle can certainly play a role, sperm health is influenced by a complex interplay of genetics, hormones, and environmental factors. A semen analysis provides objective data to dispel these myths and offer a clearer picture of fertility potential.

Supporting Each Other During the Testing Process
Couples who are undergoing fertility testing should prioritize supporting one another emotionally and physically. This might involve having open, non-judgmental conversations about the process and recognizing that fertility testing is just one step in a larger journey. Maintaining a strong connection throughout testing can help reduce the feelings of isolation or blame that sometimes arise. Additionally, celebrating small victories, such as completing tests or making positive lifestyle changes, can reinforce a sense of progress and shared commitment.

Communicating with Healthcare Providers About Concerns
It’s vital to voice any concerns or anxieties to healthcare providers during the fertility testing process. Providers can help clarify confusing aspects of the tests, explain what the results mean, and offer reassurance about the next steps. Couples should feel empowered to ask questions and discuss any fears they may have, whether they are related to the test itself, potential results, or the emotional toll of the process. Providers can also refer couples to resources such as counseling or fertility support groups to help address any emotional challenges that arise.

What If the Results Are Abnormal?
One of the most common fears couples have is what happens if the semen analysis reveals abnormal results. It’s important to understand that abnormal results don’t necessarily mean a couple won’t be able to conceive. Often, lifestyle changes, medications, or treatments like intrauterine insemination (IUI) or in vitro fertilization (IVF) can address many fertility issues. It’s essential to stay focused on solutions and remain patient, as every couple’s fertility journey is unique and may require different approaches.

Cost

A semen analysis offers a clear and valuable insight into male fertility, providing couples with essential information that can either rule out male factor infertility or highlight areas that may need attention. For those in Canada, TeleTest can provide the referral to perform the analysis, which is usually covered by provincial insurance such as OHIP.

Remember, every couple’s fertility journey is unique. If conception is taking longer than expected, seeking medical advice and considering a semen analysis can offer clarity and direction. By staying informed, patient, and proactive, couples can give themselves the best possible chance for success.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.