Why am I not getting pregnant? A fertility check-up may hold the key

At 40, you’ve spent months hoping for a positive pregnancy test. You’ve asked yourself so many questions: Is this normal? Is it harder because of my age? Am I ovulating? Is my ovarian reserve good enough? Perhaps you’ve even experienced a failed IVF…

At Vida Fertility, we truly understand this moment in your life. We see it every day in our clinic. That’s why the first thing we want you to know is: you’re not alone, and there is a path that can give you answers. That path begins with a fertility check-up.

We spoke with Dr Elena Santiago from Vida Fertility to answer common questions about fertility testing, when to see a specialist, and why a couple’s fertility check-up may be essential.

Table of contents

1. What is a fertility check-up and what does it involve?
- 1.1. Female fertility check-up
- 1.2. Male fertility check-up
2. Why is it essential to have a fertility check-up if you’re over 40?
3. What does a fertility check-up at Vida Fertility include?
4. When should you have a fertility check-up?
5. Frequently asked questions about the fertility check-up
6. Would you like to know your fertility level?
- 6.1. Ask for a consultation
- 6.2. Testimonials
7. Our fertility treatments
8. Where can I find Vida Fertility centres in Spain?
- 8.1. Vida Fertility Madrid
- 8.2. Vida Fertility Alicante

What is a fertility check-up and what does it involve?

A fertility check-up is a set of medical tests designed to evaluate the reproductive potential of a woman, a man, or a couple.

At Vida Fertility, most of the cases we handle involve women who want to become mothers after the age of 40 and have been trying unsuccessfully for over a year. In these cases, this check-up is not optional – it’s a key diagnostic necessity.

Female fertility check-up

The female fertility check-up includes a blood hormone test, with AMH being the main indicator to assess ovarian reserve. In some cases, it may also be helpful to study other hormones (FSH, LH, oestradiol, progesterone, prolactin) at specific points in the menstrual cycle. We also request general blood work and serology to rule out infections.

This is complemented by a transvaginal ultrasound to examine the uterus and ovaries and to perform an antral follicle count (AFC), which is key to estimating ovarian reserve.

Additional tests may include a karyotype to detect chromosomal abnormalities; a hysterosalpingography or hysterosonography to assess tubal patency; a hysteroscopy to identify uterine conditions such as fibroids; and an endometrial biopsy to study endometrial receptivity and microbiota.

Learn more about female fertility tests

Male fertility check-up

In many cases, difficulty conceiving is linked to low sperm concentration (oligozoospermia) or poor semen quality. When semen parameters are below normal, conception may be more difficult. However, at Vida Fertility we have the tools to identify the cause.

The process begins with a personalised fertility consultation where one of our specialists reviews your medical history, personal and family background, lifestyle habits, and performs a full physical exam. Then, a detailed check-up is carried out including seminogram, REM test (motile sperm count) , blood test, serology, and karyotype.

These tests allow us to assess sperm quality from a functional, genetic, and microscopic perspective.

Learn more about male fertility tests

Why is it essential to have a fertility check-up if you’re over 40?

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Because from the age of 35 onwards, fertility declines significantly — by now, you’ve probably heard about ovarian reserve.

There are many potential causes behind difficulty conceiving. While they may not be definitive, they do require a professional approach.

Check age limits for each fertility treatment

What does a fertility check-up at Vida Fertility include?

At Vida Fertility, we’ve developed a personalised protocol tailored specifically for women over 35 who, like you, are seeking answers to make informed decisions with confidence.

Hormonal tests

A blood test is performed to assess key hormones:

FSH, LH and Oestradiol (on day 3 of the cycle)
AMH (Anti-Müllerian Hormone)
TSH (thyroid) and Prolactin

These hormones help us evaluate your ovarian reserve, ovulatory function and detect possible endocrine disorders.

Everything about female fertility hormones

Transvaginal ultrasound

A fundamental test to visualise the uterus and ovaries. It allows us to:

Count antral follicles
Detect fibroids , polyps or uterine pathologies
Evaluate the endometrium

Hysterosalpingography (HSG)

To perform a hysterosalpingography, a contrast dye is introduced into the uterus and X-rays are used to determine whether the fallopian tubes are open.

This is essential to confirm whether the sperm can reach the egg naturally.

Genetic testing (case-dependent)

Before attempting pregnancy, ensuring the future baby’s health is vital. The Carrier Genetic Test (CGT) checks whether both partners carry the same genetic mutation. Even if they are healthy, this coincidence can result in serious genetic conditions in the baby, with a 25% risk. This test helps prevent that and, if needed, gamete donation may be advised.

We may also perform a karyotype to detect chromosomal abnormalities that could be affecting fertility or increasing the risk of recurrent miscarriage.

Male factor assessment

Let’s not forget that up to 40% of infertility cases involve the male partner. That’s why we always recommend a seminogram, and more advanced studies if necessary.

You can learn more about male fertility tests or semen-related conditions here:

Male infertility

When should you have a fertility check-up?

The medical recommendation is that if you’re over 35 and have been trying to conceive for more than 6 months without success, you should visit a specialist centre.

For women over 40, there’s no time to wait. Early detection of any potential issues can make a significant difference in treatment options and your real chances of success.

When to see a fertility specialist