Understanding the goal
If you've been trying to conceive without success, you're not alone, and there is a clear, structured path forward. This pathway is built for people who have moved past casual trying and want a real evaluation of what might be standing in the way, along with a plan that escalates appropriately rather than wasting time. The guiding principle is timing by age: general guidance suggests seeking evaluation after twelve months of regular, unprotected intercourse under age 35, or after six months for those 35 and older, since egg quantity and quality decline more quickly in this range. We recommend starting your evaluation as soon as possible because knowledge is power. If you have known risk factors, such as irregular cycles, prior pelvic surgery, endometriosis, or a partner with known fertility issues, evaluation sooner is reasonable regardless of age. The goal of this pathway is not simply to run tests, but to identify the most efficient route to pregnancy for your specific situation, whether that's a straightforward fix, ovulation induction with IUI, or moving more directly to IVF.
What we evaluate first
A thorough diagnostic workup for both partners is the foundation of an effective treatment plan. Skipping this step often leads to trial-and-error treatment that costs more time than a complete evaluation would have. Depending on your history, the initial workup typically includes:
- AMH and antral follicle count to assess ovarian reserve
- Ovulation confirmation via cycle tracking, LH testing, or progesterone bloodwork
- Hysterosalpingogram (HSG) or saline sonogram to evaluate tubal patency and uterine cavity
- Semen analysis to assess count, motility, and morphology
- Screening for conditions such as PCOS/PMOS, endometriosis, thyroid dysfunction, or fibroids
- Review of prior pregnancies, losses, or surgeries relevant to fertility
How the plan is built
Once your workup is complete, Dr. Ghadir builds a treatment plan based on the specific factors identified, your age, and how long you've been trying. Some diagnoses respond well to lower-intervention treatment first; others benefit from moving more directly to IVF. Plans are typically staged, with clear checkpoints to evaluate whether to continue, adjust, or escalate, rather than repeating the same approach indefinitely without reassessment.
First-Line Treatment: Ovulation Induction and IUI
For many patients, particularly those with ovulatory irregularities, unexplained infertility, or mild male factor, ovulation induction paired with intrauterine insemination (IUI) is a reasonable, less invasive starting point. Typically attempted for a maximum of three cycles. If future fertility for a subsequent child or other factors are present, many patients skip IUI and are recommended to proceed directly through IVF.
Escalating to IVF when appropriate
For diagnoses like tubal blockage, significant male factor, diminished ovarian reserve, or after IUI hasn't succeeded, IVF is recommended. ICSI addresses male factor directly, and PGT-A embryo testing may be offered based on age or history of loss.
Success factors and honest expectations
Success rates in fertility treatment are closely tied to age, diagnosis, and treatment type, and Dr. Ghadir will walk you through realistic, individualized expectations rather than generic statistics. IUI success per cycle is meaningfully lower than IVF success per cycle, but it's also less invasive and less costly. It's honest to say that fertility treatment is rarely a single, guaranteed step. Many patients need more than one cycle of a given treatment, and some need to move between approaches before conceiving. This isn't a sign that something is going wrong; it's a normal part of the process for many diagnoses. What matters most is that each step is chosen deliberately based on your diagnosis and response to prior treatment, not simply because it's the next protocol on a checklist. Regular reassessment ensures your plan continues to make sense as new information comes in.
Cost, insurance, and timing
At the time of your initial consultation, a financial coordinator will meet with you to discuss the cost and your current insurance coverage to ensure that financial expectations are very clear.
Emotional support and partner involvement
Trying to conceive without success for months or years is genuinely stressful, and it's common to feel isolated, frustrated, or uncertain about whether to keep going or change course. Our team recognizes this and builds in time during appointments to address the emotional weight of treatment, not just the clinical steps, and can refer you to mental health professionals who specialize in fertility. Partners are involved throughout, from semen analysis and diagnostic conversations to treatment decisions and support during procedures. Fertility challenges affect both partners, and treatment plans work best when decisions are made together with full information.
Working with Dr. Ghadir
Dr. Ghadir is a partner at HRC Fertility in Beverly Hills and holds clinical faculty appointments at multiple academic institutions, bringing academic-level rigor to a private-practice setting. Patients seeking baseline understanding benefit from his experience distinguishing meaningful clinical signals from normal variation.
Every evaluation is personalized based on your history, your goals, and your individualized treatment plan. There is no one-size-fits-all interpretation of fertility data, and Dr. Ghadir's approach reflects that throughout your visit.
What to expect
- 01
Comprehensive workup
Both partners undergo diagnostic testing, including ovarian reserve, ovulation confirmation, tubal and uterine evaluation, and semen analysis, typically completed within one to two cycles.
- 02
Diagnosis and plan discussion
Dr. Ghadir reviews all findings together and recommends a starting treatment path based on your diagnosis, age, and how long you've been trying.
- 03
First-Line Treatment
Dr. Ghadir will discuss your individualized, personalized treatment after evaluating all of your diagnostic testing and your overall goals.
- 04
Reassessment
Dr. Ghadir will review outcomes together with you and decide whether to continue, or make medication adjustments to your treatment protocol.
- 05
IVF, if indicated
For appropriate diagnoses, IVF with or without ICSI and PGT-A testing offers a more controlled and often higher-success path, spanning roughly one cycle from stimulation to transfer.
- 06
Pregnancy confirmation and transition to care
Once pregnancy is confirmed, early monitoring continues before you transition to obstetric care, with support available throughout.
Frequently asked
How long should we try before seeking help?
We recommend starting your evaluation as soon as possible because knowledge is power. General guidance suggests seeking evaluation after twelve months of regular, unprotected intercourse if you're under 35, or after six months if you're 35 or older, since fertility changes more quickly with age in this range. If you have known risk factors like irregular cycles or a prior diagnosis, earlier evaluation makes sense regardless of age.
Do we have to try IUI before IVF?
Not necessarily. IUI is often a reasonable first step for certain diagnoses like mild ovulatory issues or unexplained infertility, but for others, such as significant male factor infertility, blocked tubes, or advanced age, moving more directly to IVF is usually recommended as the more effective path.
What does the diagnostic workup cost?
Costs vary depending on which tests are recommended and your insurance coverage. Our team verifies your specific benefits before your appointment so you know what to expect financially, with no surprise billing. You will be assigned to one financial coordinator for your entire fertility journey.
How does age affect our chances?
Age is one of the strongest predictors of success at every stage of treatment, particularly for egg quality. Younger patients generally see higher success rates with both IUI and IVF, which is part of why evaluation timelines shorten with age, prompting earlier action rather than prolonged natural trying.
Will insurance cover IUI or IVF?
Coverage varies significantly depending on your state and employer; some plans include meaningful fertility treatment benefits while others cover only diagnostics. Our financial counseling team reviews your specific policy, explains what's covered, and discusses payment or financing options for anything not included.
What if my partner has a male factor diagnosis?
Male factor infertility is common and treatable in many cases. Depending on severity, options range from lifestyle changes and IUI to IVF with ICSI, which directly addresses issues with sperm count or motility by injecting a single sperm into each egg.
How many cycles of treatment do most people need?
This varies widely by diagnosis, age, and treatment type. Some conceive on a first IUI or IVF cycle, while others need multiple attempts. Dr. Ghadir sets realistic, individualized expectations and reassesses your plan after each cycle rather than assuming a fixed number will work for everyone.
What's the first step if we want to start?
Schedule an initial consultation, where Dr. Ghadir reviews your history and recommends which diagnostic tests to begin with. Most patients complete their baseline evaluation within one menstrual cycle and have a clear treatment recommendation shortly after.