Gynecology & Fertility in Charleston and Mt. Pleasant, SC

Reviewed by Ashley Harwyn, PA-C, ABAAHP  |  A4M Board Certified  |  Updated October 4, 2026

When to ask for a fertility evaluation, which tests answer which question, and why your partner belongs in the workup from the first visit.

Fertility care also comes with a lot of noise: tests sold as answers they cannot give, and remedies sold with little trial evidence behind them.[2][6] Below, we cover what each test can and cannot tell you, why your partner belongs in the workup from day one, where menstrual mapping fits, and when we hand off to a fertility specialist.

• Guidance from the American Society for Reproductive Medicine (ASRM): get evaluated after 12 months of trying if you are under 35, after 6 months at 35 or older, and sooner after 40 or with a known issue such as irregular periods.[1]
• About 1 in 5 married US women aged 15 to 49 with no prior births cannot get pregnant after a year of trying, so needing help is common.[4]
• Both partners should be checked at the same time. For men, that starts with a reproductive history and a semen analysis.[1][3]
• AMH estimates egg supply and predicts response to IVF drugs, but ASRM says it should not be used as a fertility test for women who are not known to be infertile.[2]
• In a 2025 systematic review, none of the studies of the actual seed-cycling rotation was randomized, and none tested it as a fertility treatment.[6]
• If you could become pregnant, the US Preventive Services Task Force recommends 400 to 800 mcg of folic acid every day.[5]

Everyday gynecology, start to finish

Much of what we do is ordinary, preventive women's health care. That includes cervical cancer screening with Pap smears, managing birth control, breast exams, pelvic exams, and diagnosing, treating, and preventing sexually transmitted infections through STD testing. It also covers hormone testing and therapy, prenatal care, and care before and after menopause, including hormone therapy when symptoms call for it.

Keeping this care in one place has a practical payoff. When fertility questions come up, your clinician already knows your cycle pattern, past results, and contraception history. That history matters: ASRM notes that a careful menstrual history may be all that is needed to show ovulation is happening.[1] Cycles that arrive regularly, generally every 21 to 35 days, usually mean you ovulate.[1]

Birth control and fertility planning are one ongoing conversation. The method that suits you at 26 may not suit you at 33, so we revisit the plan as your goals change.

How long to try before asking for help

The timing rules come from ASRM. If you are under 35, the usual advice is to start an evaluation after 12 months of regular, unprotected sex without a pregnancy. At 35 or older, the window shortens to 6 months, and over 40, a more immediate evaluation may be warranted.[1] The reason is simple: female age is the single strongest predictor of fertility, and fertility declines steadily as the years pass.[1][4]

Some people should not wait at all. ASRM says testing should begin without delay when there is a condition known to cause infertility.[1] That list includes irregular cycles, cycles shorter than 25 days, periods that are rare or absent, known or suspected endometriosis or tubal disease, known male fertility problems, sexual dysfunction, and past cancer treatment that can affect the ovaries.[1]

You are also far from alone. CDC data show that about 1 in 5 (19%) of married US women aged 15 to 49 with no prior births are unable to get pregnant after a year of trying.[4] It can come from male factors, female factors, or both, so a fair workup looks at the couple, not just the person who came in first.[3][4]

Fertility tests, and the question each one answers

A fertility workup is really three questions. Is ovulation happening? Are the tubes and uterus normal? Is the sperm healthy? ASRM frames the core evaluation the same way: ovulation, the reproductive tract, and a semen analysis for the male partner.[1] Each test answers one piece, and none answers all of it.

Progesterone timing trips people up. The draw should land about one week before your next expected period, not on a fixed “day 21,” because cycle lengths differ.[1] One result can confirm you ovulated, but it cannot grade the cycle, because levels swing widely within hours.[1]

AMH needs a warning label, because the old version of this page called it a fertility test. It is an egg-supply estimate. AMH falls as the number of ovarian follicles falls with age, and in IVF it predicts well how many eggs a stimulation cycle will yield.[2] For natural conception, ASRM calls ovarian reserve markers poor predictors of reproductive potential apart from age, and says they should not be used as a fertility test for women who are not infertile or have not yet tried.[2] A low AMH in a woman without infertility does not predict her short-term fertility.[1] We order AMH when it helps plan treatment, never as a verdict.

The male side of the workup starts at the same time as yours. The AUA/ASRM guideline calls for a reproductive history and one or more semen analyses, with at least two samples about a month apart, especially if the first one comes back abnormal.[3] Even then, a value above or below the lower reference limit does not by itself predict fertility or infertility.[3] Men with abnormal results should see a male reproductive specialist, and anabolic steroid use is worth raising early, because ongoing use suppresses sperm production.[3] We offer hormone testing for women and men as well as semen analysis, so both partners can be evaluated together.

Seed cycling, herbs, and supplements: what has been tested

Seed cycling is the practice of eating flax and pumpkin seeds in the first half of the cycle and sesame and sunflower seeds in the second half, on the theory that this nudges estrogen and progesterone.[6] Our old page offered it, along with herbal remedies, as a fertility approach. We have removed both, for these reasons.

A 2025 systematic review searched for studies from 2015 to 2025 on seed cycling or its individual seeds in women with PMS or polycystic ovary syndrome (PCOS). It found 10 studies with 635 women in total.[6] Only four used the actual four-seed rotation: three studies with no randomized comparison group and one single-patient case report. The two randomized trials in the review tested flaxseed alone.[6] None of the studies was a trial of seed cycling as a fertility treatment. The authors themselves call the evidence small and of moderate quality and ask for larger randomized trials.[6] As a way to get pregnant, seed cycling is untested.

Herbal products raise a different issue. The FDA does not have the authority to approve dietary supplements before they are sold, so a bottle labeled for fertility or hormone balance did not need FDA approval to reach the shelf.[7] Some supplements can also interact with medicines or with each other.[7] If you take anything, from a prenatal vitamin to a hormone blend, bring the bottles to your visit.

Past the point the guidance says to wait, or unsure where you fall? Call 843-981-0870 to book a visit. Bring your cycle dates and any old lab results. We will go through your history, order only the tests that fit, and bring your partner into the workup from the start.

Getting ready for pregnancy, and when we refer

The US Preventive Services Task Force gives an A grade to a daily supplement with 400 to 800 mcg of folic acid for anyone planning or able to become pregnant.[5] The protection matters most from at least a month before conception through the first two to three months of pregnancy, and since nearly half of US pregnancies are unplanned, the advice applies even if a baby is not on this year's calendar.[5] A preconception visit is also the time to review medicines, check that your routine labs are current, and plan when to stop birth control.

We also know where our role ends. When the workup points to blocked tubes, a uterine problem, or a sperm problem, or when you are not pregnant within the time frame you set, we refer you to a fertility specialist and pass along what we have found so far. Over 40, that referral usually comes sooner, in line with ASRM guidance.[1]

One patient shared this about her care: “After 2 years of infertility problems, Ashley was the only doctor who wanted to help when I felt there was something off with my hormones. She is a very caring person and I'm so happy I found her when I did. Now I'm pregnant with my rainbow baby!” This is one person's experience. Individual results vary, and no clinic can promise a pregnancy.

Ashley Harwyn, PA-C, leads this care. She is board certified in anti-aging and functional medicine (A4M) and holds ABAAHP certification. Visits take place at our Mount Pleasant office at 496 Bramson Ct, Ste 120, or downtown at The Longevity Club, 163 Rutledge Ave, Ste 202, in Charleston.