GPAtlas🧭 When to suspect
Infertility (subfertility) is the failure to conceive after 1 year of regular unprotected vaginal intercourse in the absence of a known cause. It is common – affecting around 1 in 7 couples – and responsibility lies with the female partner, the male partner, both, or is unexplained in broadly equal proportions. For that reason both partners must always be assessed together, never the woman alone.
Most couples having regular intercourse conceive without intervention: over 80% do so within a year if the woman is under 40, and about half of the remainder conceive during the second year. The single dominant prognostic factor is the woman's age, and female fertility declines appreciably from the mid-30s. The two core primary-care tasks are therefore to start timely, parallel investigation of both partners and to lower the threshold for earlier referral whenever age or a known cause makes delay costly.
| Clinical situation | When to investigate / refer |
|---|---|
| Regular unprotected intercourse, no known cause | Investigate after 1 year |
| Woman aged 36 years or over | Investigate and refer earlier – after about 6 months |
| Known cause or predisposing factor (amenorrhoea, prior chlamydia/pelvic inflammatory disease, undescended testes, prior chemotherapy) | Investigate and refer without the 1-year wait |
| Planned gonadotoxic treatment (e.g. chemotherapy, radiotherapy) | Refer for fertility preservation before treatment begins |
| Female same-sex couple, single woman, or known need for donor gametes | Refer to fertility services per local pathway |
Source: NICE NG257
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