Counsel both partners together, if possible. A man may blame his partner for infertility when he himself may be responsible for the inability of the woman to become pregnant or to maintain a pregnancy.
Explain that a man is just as likely to have fertility problems as a woman. In more than 40% of couples with fertility problems, it is because of semen or sperm abnormalities, or other health problems of the male partner. In 20% of couples with fertility problems, both male and female factors reduce fertility. Sometimes it is not possible to find the cause of the problem.
Recommend that the couple attempt pregnancy with unprotected sex for at least 12 months before they suspect infertility. Provide educational materials and guidance on risks to fertility.
The most fertile time of a woman’s cycle is several days before and at the time of ovulation (when an ovary releases an egg) (see The Menstrual Cycle). Fertility awareness methods can help couples identify the most fertile time of each cycle (see Fertility Awareness Methods). Provide educational material about these methods and/or refer the couple to a fertility care provider or specialist.
If, after one year, following the suggestions above has not resulted in a pregnancy or live birth, refer both partners to a qualified fertility care provider for evaluation and assessment, if available. Referral to a fertility care provider or specialist may be particularly helpful in the following situations: the couple is affected by HIV or suspected genital TB; the woman is age 35 or older; she has polycystic ovary syndrome or has been diagnosed with endometriosis; the woman or the man suspects they had an STI and it was not treated; either had been treated for a cancer or had surgery that may have affected the reproductive tissues or organs.
The couple also may want to consider adoption or other alternatives to having children or more children of their own, such as taking in nieces and nephews.