Testing is generally recommended after twelve months of trying to conceive without success, or after six months if the age of partners are advanced. However, certain signs warrant earlier evaluation regardless of how long the couple has been trying: a history of undescended testes in childhood, previous testicular surgery or trauma, recurrent respiratory infections (which can point to genetic conditions like cystic fibrosis affecting CFTR), a family history of infertility or genetic conditions, very low sex drive, erectile or ejaculatory difficulties, or a visibly enlarged or twisted scrotal vein suggestive of varicocele. Men with these risk factors should not wait the full year before consulting a specialist.