Signs of Infertility in Women and Men | Damien Fertility Partners
Infertility affects approximately 1 in 8 couples in the United States, according to CDC ART surveillance data. In New Jersey alone, 5.6% of all infants born in 2022 were conceived through assisted reproductive technology — the second-highest state rate in the country, behind Massachusetts. Those numbers reflect a large population of patients who needed answers before they could move forward. Most of them had questions well before they had a diagnosis.
Damien Fertility Partners has provided fertility evaluation and treatment across New Jersey since 1989, with offices in Shrewsbury (Monmouth County), Newark (Essex County), and Jersey City (Hudson County). Our embryology laboratory holds accreditation from the College of American Pathologists (CAP), the FDA, and the NJ State Department of Health, all with zero deficiencies. The same physician stays with you through every consultation, monitoring visit, and procedure — a structure that matters when you are trying to understand complex results quickly.
Defining Infertility
Infertility is clinically defined as the inability to conceive after 12 months of regular, unprotected intercourse — or after 6 months if you are 35 or older. That definition comes from ASRM and is the standard used by reproductive endocrinologists to guide evaluation timing. It is a medical condition with identifiable causes in the majority of cases. It is not a reflection of effort, lifestyle, or desire.
The 12- and 6-month thresholds are guidelines, not waiting requirements. If you have a known risk factor — irregular cycles, a history of pelvic infections, prior miscarriage, or a male partner with suspected sperm issues — earlier evaluation is appropriate. Waiting for a calendar milestone when a clinical reason to act already exists rarely serves the patient.
Signs of Infertility in Women
Irregular or absent periods. A normal menstrual cycle runs between 21 and 35 days. Cycles that are consistently shorter, longer, or absent altogether may indicate polycystic ovary syndrome (PCOS), thyroid dysfunction, or hypothalamic amenorrhea — all of which can disrupt ovulation and impair conception. PCOS alone is one of the most common causes of female infertility, and it frequently presents with cycle irregularity as the first noticeable sign.
Painful or heavy periods. Pain that is severe enough to interfere with daily activities, that radiates to the lower back or legs, or that has worsened over time may signal endometriosis. Endometriosis affects an estimated 10% of women of reproductive age and is among the most common structural causes of infertility, according to ASRM. Abnormally heavy bleeding may point to uterine fibroids or polyps, both of which can affect implantation and pregnancy outcomes. Surgical evaluation for these conditions is handled in-house by Dr. Nina Seigelstein — patients are not referred out.
Hormonal symptoms. Sudden weight gain or loss, excessive facial or body hair, adult acne, or milky nipple discharge unrelated to breastfeeding are all clinical signals of potential hormonal imbalance. PCOS frequently presents with this combination. Tracking ovulation with a predictor kit and finding consistently absent or irregular LH surges is another meaningful finding worth raising at your first appointment.
Reproductive history that warrants earlier evaluation. A personal history of pelvic inflammatory disease (PID), chlamydia, gonorrhea, prior ectopic pregnancy, or two or more miscarriages all justify earlier evaluation — regardless of how recently you began trying. Two or more miscarriages meet the clinical threshold for recurrent pregnancy loss (RPL) and should prompt a comprehensive workup. Waiting for a third loss before seeking evaluation is not necessary and is not recommended by ASRM.
Signs of Infertility in Men
Changes in sexual function or ejaculation. Difficulty with erection or ejaculation, reduced libido, or pain and swelling in the testicular area are all worth discussing with a specialist. These symptoms may be associated with hormonal imbalances, varicocele (a dilation of veins within the scrotum and one of the most common treatable causes of male infertility), or other structural factors affecting sperm production and delivery.
Hormonal and physical signs. Decreased facial or body hair, changes in muscle mass, or gynecomastia (enlarged breast tissue) can reflect hormonal abnormalities that compromise the environment supporting sperm production. A semen analysis and hormonal blood panel can quickly clarify whether these findings are connected to a fertility issue. In many cases, the underlying cause is treatable once it is identified.
Infertility Without Symptoms
Many of the most common causes of infertility present with no outward signs at all. Diminished ovarian reserve (DOR) typically produces no symptoms — it is identified through anti-Müllerian hormone (AMH) testing and antral follicle count (AFC) on ultrasound, not through anything a patient notices day to day. Blocked fallopian tubes are largely asymptomatic and often go undetected for years. Male infertility is frequently silent: sperm count, motility, and morphology cannot be estimated from physical symptoms alone — a semen analysis is required.
The absence of symptoms does not mean the absence of a fertility issue. A proactive evaluation and diagnosis is often the only way to identify barriers before more time passes.
Deciding when to See a Fertility Specialist
The standard timing thresholds — 12 months of trying if you are under 35, 6 months if you are 35 or older — are reasonable starting points. They are not reasons to delay when a clinical signal is already present.
Earlier evaluation is appropriate if you have a diagnosis of PCOS, endometriosis, or uterine fibroids; if you have a history of pelvic infections or prior ectopic pregnancy; if your cycles are absent or highly irregular; if you have experienced two or more miscarriages; or if your male partner has known or suspected sperm issues. Immediate evaluation is appropriate for anyone facing a medical diagnosis — such as cancer — that may require treatments known to affect fertility. In those cases, fertility preservation options including egg freezing should be discussed before treatment begins.
Fertility Evaluation at Damien Fertility Partners
A fertility evaluation at our practice is a comprehensive, individualized assessment — not a standard checklist. For women, this includes hormonal blood work, ovarian reserve testing (AMH and AFC), and uterine imaging. For men, a semen analysis is performed alongside hormonal panels when clinically indicated. Both partners are evaluated simultaneously so no time is lost to a sequential workup.
Dr. Miguel Damien is trained at Dartmouth and Harvard, board-certified in reproductive endocrinology and infertility by the American Board of Obstetrics and Gynecology (ABOG), and named a Top Doctor in the NY Metro Area by Castle Connolly six times (2005, 2007, 2008, 2010, 2017, 2018). Dr. Barry Perlman holds ABOG board certification in REI as well. Both physicians are board-certified — a distinction that matters because not every provider who calls themselves a “fertility specialist” holds that credential.
Our practice has no BMI-based limitations on care and provides dedicated support for LGBTQ+ family building, services for singles, and patients pursuing donor sperm or donor egg IVF. Dr. Damien is fluent in Spanish, and a bilingual Insurance Verification Specialist is available to assist with insurance and financial questions at all three offices.
Frequently Asked Questions
What is the clinical definition of infertility?
Infertility is defined by the American Society for Reproductive Medicine as the inability to conceive after 12 months of regular, unprotected intercourse, or after 6 months if the female partner is 35 or older. These thresholds guide when evaluation is indicated, but patients with known risk factors should be seen earlier regardless of how long they have been trying.
Is infertility more often a female or male issue?
Neither. Male factor infertility contributes to approximately 40–50% of all cases, either alone or in combination with a female factor. Evaluating only one partner delays diagnosis and can lead to unnecessary treatment. At our practice, both partners are assessed simultaneously from the first evaluation.
Can you be infertile with no symptoms?
Yes. Diminished ovarian reserve, blocked fallopian tubes, and male factor infertility — including low sperm count and poor motility — are frequently asymptomatic. Blood work, ultrasound, and semen analysis identify issues that have no outward signs. Waiting for symptoms to appear before seeking evaluation is not a reliable strategy.
What does a fertility evaluation include?
For women, a basic evaluation includes hormonal blood work, AMH testing, antral follicle count via transvaginal ultrasound, and uterine imaging. For men, a semen analysis is the primary first step, with hormonal panels added when indicated. All testing is performed in-house at our Shrewsbury, Newark, and Jersey City offices.
At what point do recurrent miscarriages warrant a specialist visit?
Two or more miscarriages meet the ASRM threshold for recurrent pregnancy loss and warrant a full evaluation, including assessment for structural uterine abnormalities, chromosomal factors, and immunological conditions. Waiting for a third loss before seeking help is not necessary or clinically advisable.
Does Damien Fertility Partners see patients who are just starting to think about conception?
Yes. A confirmed fertility problem is not required to schedule a consultation. Many patients come to us for proactive ovarian reserve assessment, family planning discussions, or to explore egg freezing before they are ready to conceive. Request a consultation at any stage.
Start With an Evaluation
Uncertainty about fertility is best resolved with data, not with waiting. A single evaluation — blood work, ultrasound, semen analysis — can identify or rule out the most common causes of infertility and give you a clear picture of where you stand and what options are available.
We see patients for fertility evaluations at three offices across New Jersey: Shrewsbury in Monmouth County, Newark in Essex County, and Jersey City in Hudson County. Dr. Damien and Dr. Perlman lead all evaluations, and the same physician who reviews your results will be with you through every subsequent step of your care. Virtual consultations are available with Dr. Perlman for patients who prefer to begin remotely.
Request a consultation with Dr. Damien or Dr. Perlman to get your questions answered and take the first step toward building your family.