If you have been trying to conceive without success, a fertility evaluation may help identify the possible reasons. Couples are generally advised to consult a fertility specialist if pregnancy has not occurred after 12 months of regular, unprotected intercourse when the female partner is under 35, or after 6 months when she is 35 or older. Earlier evaluation may be recommended for people with irregular periods, known reproductive health conditions, or other fertility concerns.
Infertility testing, also known as a fertility workup, is an important first step in understanding the factors that may affect conception. It involves evaluating the reproductive health of both partners to identify potential causes and guide appropriate treatment.
At Jyoti IVF, fertility evaluation may include a review of medical history, physical examinations, blood tests, ultrasound scans, and other diagnostic procedures, depending on each individual’s needs. Understanding the underlying cause can help your doctor recommend a suitable treatment plan.
Before exploring the testing process, it is helpful to understand the common causes of infertility.
What Causes Infertility?
Infertility can result from several factors affecting either partner, and sometimes the cause may remain unexplained even after evaluation.
In women, common factors include irregular ovulation, hormonal imbalances, polycystic ovary syndrome (PCOS), blocked fallopian tubes, uterine fibroids, endometriosis, and age-related changes in fertility.
In men, fertility may be affected by low sperm count, reduced sperm motility, abnormal sperm morphology, hormonal imbalances, genetic factors, or problems involving the reproductive organs.
Other factors, including certain medical conditions, sexually transmitted infections, smoking, excessive alcohol consumption, and significant weight-related concerns, may also influence reproductive health.
Identifying the possible cause through appropriate medical evaluation helps fertility specialists determine the next steps and discuss available treatment options.
How Is Infertility Diagnosed?
Infertility diagnosis generally begins with a comprehensive assessment of both partners. The doctor reviews their medical and reproductive histories, discusses how long they have been trying to conceive, and recommends investigations based on their individual circumstances.
For women, the evaluation may focus on ovulation, hormone levels, ovarian reserve, the uterus, and the fallopian tubes. For men, the assessment usually includes semen analysis and may involve additional hormonal or reproductive investigations when indicated.
Not every person requires every available test. The fertility specialist determines which investigations are appropriate based on the initial findings.
A. Female Fertility Assessment
A female fertility assessment begins with a detailed medical history and may include a physical examination and diagnostic tests.
The doctor may ask about:
- Menstrual cycle regularity, duration, and flow.
- Previous pregnancies, miscarriages, or fertility treatments.
- History of pelvic infections, endometriosis, or abdominal surgery.
- Existing medical conditions and medications.
- Lifestyle factors that may affect reproductive health.
- Family history of reproductive or hormonal conditions.
The following investigations may be recommended depending on the clinical assessment.
1. Blood Tests
Blood tests may be used to assess hormone levels associated with ovulation and ovarian function. Depending on the situation, these may include follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), thyroid-stimulating hormone (TSH), and prolactin. Progesterone testing may also help assess whether ovulation has occurred.
2. Urine Ovulation Test
An ovulation predictor kit detects the luteinizing hormone (LH) surge that typically occurs before ovulation. These tests can help identify the most fertile days of the menstrual cycle, although they do not confirm every aspect of ovulatory function.
3. Pelvic Ultrasound
A pelvic ultrasound helps examine the uterus and ovaries. It can identify certain structural abnormalities, ovarian cysts, fibroids, and other findings that may affect fertility. A transvaginal ultrasound may provide more detailed images when appropriate.
4. Hysterosalpingography (HSG)
Hysterosalpingography is an imaging procedure used to assess the uterine cavity and whether the fallopian tubes are open. A contrast material is introduced through the cervix, and X-ray images are taken to evaluate the reproductive structures.
5. Hysteroscopy
Hysteroscopy involves inserting a thin instrument with a camera through the cervix into the uterus. It allows the doctor to examine the uterine cavity and, when necessary, investigate or treat certain abnormalities, such as polyps or adhesions.
6. Pap Smear
A Pap smear screens for abnormal cervical cells and may be recommended as part of routine cervical health care. It is not a direct test of fertility, but cervical screening may be relevant to a patient’s overall reproductive healthcare.
7. Endometrial Biopsy
In selected cases, an endometrial biopsy may be recommended to collect a small sample of tissue from the uterine lining. This test is not routinely required for every infertility evaluation and is performed only when clinically indicated.
The exact combination of tests depends on the patient’s medical history, symptoms, age, and initial