We’ve Been Trying to Get Pregnant for a Year—What Now?

You decided you were ready. You pulled the goalie. Maybe you started taking prenatal vitamins, tracked your cycle, or began eyeing ovulation test strips like they held the secrets of the universe. But here you are—one year later—and still no positive test.

So… what now?

Let’s walk through it. This is what I call the fertility runway. Everyone's path looks a little different.

And if you’ve been trying to conceive (TTC) for a year, or six months if you’re over 35, it’s officially time to schedule a fertility workup.

And to be clear: you don’t have to wait until you hit that exact calendar date to get support. If you’re feeling antsy, if your gut says something’s off, or if you just want answers—you can always ask your provider to start the process earlier.

Step One: Dig Into the Data

A fertility workup is a deeper look into what your body (and your partner’s body) is doing behind the scenes. Even if your cycles seem regular, it doesn’t mean everything is syncing up optimally for pregnancy.
Make sure you’ve been tracking your cycles and bring that information with you to see the clinician to review it. The more data you have, the better!

Here’s what it typically includes:

• Cycle Day 3 Bloodwork: Done early in your cycle, this measures hormone levels like FSH, LH, estradiol, TSH, and AMH (a marker of ovarian reserve).

• Semen Analysis: Yep, it’s not just about the person with the uterus. In fact, male-factor infertility accounts for 40–50% of cases. This test is usually done outside the fertile window and looks at sperm count, movement (motility), and shape (morphology).

• Ultrasound: Usually transvaginal, this gives a detailed look at your ovaries and uterus to rule out issues like cysts, fibroids, or signs that you may not be ovulating.

Step Two: The Fertility Runway

Once that initial testing is complete, you and your provider can map out your next steps. This is where the fertility runway comes in—a progression from lower- to higher-intervention options that you can step through depending on what your body needs.

✈️ Timed Intercourse

This is the first stop. You track your ovulation—either with apps, ovulation predictor kits (OPKs), or more clinical monitoring—and time sex around your most fertile days.

Sometimes your provider might recommend medications like Clomid or Letrozole to help stimulate ovulation or fine-tune your cycle.

✈️ Intrauterine Insemination (IUI)

If you’ve tried timed intercourse for several cycles with no success—or if you’re using donor sperm, dealing with mild male-factor infertility, or have certain hormonal issues—you might move to IUI.

Here’s how it works:

• You can do IUI on a natural cycle, using your body’s natural ovulation timing.

• Or, it can be paired with ovulation induction, where meds help you release an egg (or sometimes more than one), and sperm is placed directly into the uterus by a clinician during that fertile window.

✈️ In Vitro Fertilization (IVF)

IVF involves stimulating your ovaries to grow multiple follicles, retrieving the eggs, fertilizing them in a lab, and transferring an embryo back into your uterus.

IVF may be recommended if:

• You’ve tried other options without success,

• You have more significant fertility factors (like blocked fallopian tubes, diminished ovarian reserve, or severe male-factor infertility),

• Or you're pursuing fertility preservation, donor eggs, or genetic testing.

Step Three: Know Before You Go—Check Your Insurance

Before diving into any part of the fertility runway, take a beat and check your insurance.

Infertility care can be shockingly expensive, and coverage varies wildly depending on your state, your plan, and your employer. Some insurance plans cover diagnostic testing only. Some offer partial or full coverage for IUI or IVF. Others offer nothing at all.

It’s frustrating—but knowing what’s covered (and what isn’t) gives you the power to make informed choices for both your health and your budget.

Call your insurance provider. Ask questions. And don’t be afraid to get it all in writing.

Final Thoughts

Struggling to get pregnant doesn’t mean you did something wrong. It doesn’t mean you’re broken. And it definitely doesn’t mean you’re alone.

Fertility challenges are incredibly common—and so is the silence that surrounds them.

So if your TTC journey is stretching longer than expected, this is your permission slip:
Call your provider. Ask for the workup. Learn your options.

You deserve answers. You deserve support.
And you deserve a team that walks beside you, every step of the runway.