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. 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, 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 three to four cycles before reassessing.
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, which is why it remains a reasonable first step for the right candidates.
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
Costs escalate with treatment intensity: diagnostic workups are the least expensive step, ovulation induction and IUI cycles are moderate, and IVF represents the largest investment, particularly with add-ons like ICSI or PGT-A. Insurance coverage varies enormously by state and employer; some plans cover diagnostics but not treatment, while a smaller number offer meaningful IVF benefits. Our financial counselors review your specific plan and outline any financing or multi-cycle package options.
Timing depends on your stage: the initial workup takes about one cycle, IUI cycles run about two to four weeks each with results known quickly, and an IVF cycle typically spans four to six weeks from stimulation to embryo transfer or pregnancy test. Staying informed at each stage helps you plan work, travel, and finances around treatment.
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. Shahin Ghadir is a founding partner of the Southern California Reproductive Center (SCRC) and serves on the clinical faculty at Cedars-Sinai Medical Center, combining broad clinical experience with academic rigor. For patients navigating the escalation from trying naturally to active treatment, his approach favors clear staging and honest communication over a one-size-fits-all protocol.
Every treatment plan is built around your specific diagnosis, prior history, and goals, with regular checkpoints to reassess. You'll always understand why a particular step is recommended and what comes next if it doesn't succeed on the first attempt.
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 (if appropriate)
For many diagnoses, ovulation induction combined with IUI is attempted for several cycles, with monitoring and dose adjustments along the way.
- 04
Reassessment
After a defined number of cycles, you and Dr. Ghadir review outcomes together and decide whether to continue, adjust medication, or move to IVF.
- 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?
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?
The initial workup is generally the least expensive stage of fertility care, since it involves bloodwork, ultrasound, and a semen analysis rather than treatment. Costs vary based on your insurance coverage, which we verify in advance so you understand your specific out-of-pocket responsibility before testing begins.
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 workup within one to two cycles and have a clear treatment recommendation shortly after.