Written by Francesca Steyn, NMC-registered fertility practitioner
Twelve months is the point where UK guidance changes. If you have been trying to conceive for 12 months, NICE (National Institute for Health and Care Excellence) says both partners should be offered further assessment. Most couples reach that point without knowing the guidance exists, let alone what it says. Here is the sequence.
What twelve months means, and what it does not mean
It is a trigger for investigation. It is not a diagnosis, and it is not a deadline.
The figure exists because of what normally happens in that window. NICE NG257, the 2026 fertility guideline, states that over 80% of heterosexual couples will conceive within a year where the woman is under 40 and they are having regular unprotected intercourse. Of those who do not conceive in the first year, about half will do so in the second, taking the cumulative rate to over 90% (recommendation 1.4.1).
So reaching a year is common enough that the guidance plans for it, and a meaningful share of couples at that point go on to conceive in year two without any intervention at all. What the twelve month mark does is move you from waiting to finding out. The specific wording is recommendation 1.16.5: after a year of trying, and with no already suspected cause, a clinician should "offer both partners further clinical assessment and investigation".
NICE also advises that intercourse every two to three days optimises the chance of pregnancy (1.5.1), which is a lower-effort approach than timing to ovulation and one many couples have not been told. If you are earlier in this than twelve months, our post on what to do at six months covers that stage.
Why both partners, not just one
Those two words, "both partners", are the part worth holding onto.
Fertility assessment has historically started with the woman and worked outwards, and in practice that habit persists. It is not what the guideline says. The Human Fertilisation and Embryology Authority (HFEA) puts it plainly: a sperm-related cause is involved in around half of all infertility cases in heterosexual couples. Assessing one partner and not the other leaves half the picture blank, and a couple can spend months in that position before anyone suggests a semen analysis.
If you are the man in this situation, there is a good case for going first, or at least at the same time. It is the simplest test in the sequence by a wide margin.
What a GP will typically do
Expect a conversation before any tests. The GP will ask how long you have been trying, how frequently, about cycles, and about medical history on both sides.
On his side, the first test is a semen analysis, measured against the World Health Organisation (WHO) reference values NICE sets out in 1.17.1: 1.4 ml or more of semen, 16 million sperm per ml or more, 39 million or more in total, 42% or more motile, 4% or more normal forms. If that result is abnormal, a repeat confirmatory test is offered, ideally three months later (1.17.3 and 1.17.4). For men with two or more abnormal analyses, the guideline adds a physical examination and says testosterone and gonadotrophin levels should be considered (1.17.5).
On her side, a mid-luteal progesterone blood test to confirm ovulation is offered even where cycles are regular (1.18.7). Where there is no known pelvic condition, a hysterosalpingogram is offered to check whether the fallopian tubes are open (1.18.13); where there is, a laparoscopy is used instead. Tests of ovarian reserve such as anti-Müllerian hormone come later and sit in specialist care, because NICE is explicit that they should not be used to predict the chance of conceiving naturally (1.18.3).
One important exception. NG257 says to offer a specialist referral at presentation, without waiting out the year, if the woman is 36 or over, or either partner has a known or suspected cause of infertility or a history of predisposing factors (1.16.8). If that describes your situation, it is worth saying so at the appointment.
Waits between each of these steps vary a lot depending on where you live, which is the part nobody can give you a reliable number for. The guideline also says counselling should be offered before, during and after investigation and treatment, whatever the outcome (1.2.3 and 1.2.4). It is routinely not mentioned, and it is reasonable to ask for it.
What you can find out at home in the meantime
The semen analysis is the one piece of this you can bring forward yourself, and it is the piece most likely to sit in a queue.
Doing it at home does not replace the GP conversation, and it should not. What it does is let you walk into that appointment with a lab result already in hand rather than joining the back of a waiting list to generate one. If the result is normal, that is a genuine piece of information and it redirects attention elsewhere. If it shows something, you have started the three month repeat clock earlier than you otherwise would have.
A Malebox test is analysed by an andrologist registered with the Health and Care Professions Council (HCPC) against WHO guidelines and explained by an NMC-registered fertility practitioner on a video call rather than emailed to you as a set of numbers. The sperm test on its own is £180, and with a consultation it is £240. If you want to know what the process involves first, we have written up what to expect before taking a fertility test.
Where the hormone profile fits
The £320 version adds a full hormone panel: follicle-stimulating hormone (FSH), luteinising hormone (LH), total and free testosterone, oestradiol, prolactin, sex hormone binding globulin (SHBG) and DHEA sulphate.
Be clear about what that is and is not. The NHS pathway reaches hormones after two abnormal semen analyses, which is a reasonable use of resources and, with the three month repeat interval, some way off. Taking both at once is not what NICE recommends for everyone at twelve months, and we are not going to claim it is. What it does is compress the sequence, so that if the semen result raises a question, the answer is already on the same report instead of two tests and several months further on.
If you are at twelve months and want the fullest single picture, that is the case for it. If you want the semen analysis and nothing more, the £180 test is the right one.
Frequently Asked Questions
Is twelve months a cut-off for getting help?
No. It is the point at which NICE says both partners should be offered assessment. Conception still happens after a year without intervention: NICE says about half of couples who do not conceive in the first year will do so in the second.
What if we are over 35?
NICE advises offering a specialist referral at presentation, without waiting a full year, if the woman is 36 or over, or if either partner has a known or suspected cause of infertility. Say this to your GP if it applies to you.
Do we have to go through the GP first?
In practice, yes. NHS fertility investigation and NHS-funded treatment normally start with a GP referral, and some services also accept a referral from another NHS doctor. Funding decisions are then made locally. You can arrange a private semen analysis independently at any point.
What does NICE say about how often to have sex?
Recommendation 1.5.1 says vaginal sexual intercourse every two to three days optimises the chance of pregnancy. That is simpler than timing to ovulation and is what the guideline actually advises.
Which partner should be tested first?
NICE says both. In practice the semen analysis is the quickest and least invasive test in the sequence, so there is a practical argument for the man not waiting to be asked.
Twelve months is not a verdict on anything. It is the point at which the sensible move changes from waiting to finding out, for both of you, and knowing the sequence in advance makes that a much shorter conversation with your GP.
Francesca Steyn is an NMC-registered fertility practitioner with over 20 years in reproductive health. She has served on the NICE guideline committee and the HFEA legislative reform group.
