Basic Infertility Evaluation for Couples

What Is Infertility?

Infertility is failure to achieve pregnancy after 12 months of regular, unprotected sexual intercourse in couples in which the female partner is younger than 35 years.

For couples in which the female partner is 35 years of age or older, infertility evaluation should be initiated after 6 months of unsuccessful attempts to conceive.

What Is Infertility Workup?

An infertility workup is a systematic evaluation consisting of a detailed medical history, physical examination, and appropriate investigations of both the male and female partners to assess their reproductive health. It helps identify the underlying cause of infertility, including ovulatory disorders, hormonal imbalances, male factor abnormalities, tubal or uterine pathology, and other anatomical or systemic conditions that may impair fertility.

When Should Couple Seek Infertility Evaluation?

If couples are not successful in achieving pregnancy after the suggested time frame, then they should consider discussing their issue with an infertility specialist.

Routine assessment may be needed earlier for women who have

• irregular periods or absent periods
• Polycystic ovarian syndrome(PCOS)
• A history of pelvic inflammatory disease
• Endometriosis
• A history of recurrent miscarriages
• Prior pelvic or tubal surgery.

It’s also important to check men who have

• erectile dysfunction
• any reproductive conditions or abnormalities, or have had such issues before.

It’s best to see your gynaecologist or fertility specialist right away if you have any concerns with your fertility.

Why It Is Important To Evaluate Both The Partners?

Infertility is a common condition which can be caused by a factor in either man or woman. Male factors play a role in almost half of the cases of infertility, and female factors play a major role as well. Evaluation of both partners at the same time enhances the accuracy of diagnosis and facilitates quicker treatment plans.

What Information is collected during the medical history ?

The usual questions that health care providers will ask are:

What Is the duration of the Infertility?

Sexual history- Frequency and timing of intercourse?

• Menstrual Cycle
• Previous Pregnancies
• Contraceptive history
• Medical Conditions
• Surgeries
• Medications
• Lifestyle Habits
• Family History

This information can be used to identify possible causes that can be further investigated.

How Is the Uterus Evaluated?

The uterus is evaluated using one or more of the following investigations:

• Pelvic ultrasonography (transabdominal and/or transvaginal)
• Saline infusion sonography (SIS)
• Hysteroscopy
• Other imaging modalities, such as hysterosalpingography (HSG) or magnetic resonance imaging (MRI), when indicated

These investigations help detect uterine fibroids, endometrial polyps, intrauterine adhesions (Asherman syndrome), congenital uterine anomalies, and other structural abnormalities that may impair implantation or increase the risk of pregnancy loss. Early identification and appropriate management of these abnormalities can improve fertility outcomes.

How To Find Any Tubal Blockage?

The healthy fallopian tubes allow the egg and sperm to meet, which is the key to natural conception.

The most frequent test used to check for tubal patency is a hysterosalpingography (HSG) which is a procedure that involves injecting a dye into the fallopian tubes and taking an X-ray to spot tubal blockages.

Women who have had a pelvic infection, ectopic pregnancy or abdominal surgery should see a gynaecologist to see if there is a need for fallopian tube testing.

How Is Ovulation Assessed?

An Ovulation assessment can be used to check if an egg is being released regularly in the menstrual cycle.

Evaluation can involve their –

• menstrual history
• a serum progesterone test
• ultrasound evaluation ( Follicular monitoring )
• ovulation predictor kits

Women with absent, infrequent or irregular menstrual periods may not be ovulating regularly and should seek evaluation by a gynaecologist or fertility specialist

What Tests Are Done To Assess Ovarian Reserve?

Ovarian reserve refers to the quantity of remaining ovarian follicles and provides an estimate of a woman’s reproductive potential. The most commonly used tests to assess ovarian reserve include:

• Anti-Müllerian Hormone (AMH)
• Day 2–3 Follicle-Stimulating Hormone (FSH) and Estradiol (E₂) levels
• Antral Follicle Count (AFC) by transvaginal ultrasonography

These tests help estimate ovarian reserve, predict the ovarian response to stimulation, and guide counselling and selection of appropriate fertility treatment.

What Lifestyle Factors Affect Fertility?

There are some factors that can have a negative effect on fertility in both men and women.

Smokingexcessive alcohol intake.Obesitypoor diet.lack of physical activity.chronic stress.drug use.

Adopting a healthy lifestyle can improve reproductive health and optimize the chances of conception. Couples planning pregnancy should consult a gynaecologist or fertility specialist for individualized preconception counselling and guidance on lifestyle modifications that may enhance fertility and promote a healthy pregnancy.

What Is Semen Analysis?

Semen analysis is the most important part of the male infertility assessment.

It is a test that assesses the,

• Sperm Concentration.
• Motility
• Morphology
• Semen Volume.

If the tests are abnormal, it may be a sign of male factor infertility and should be investigated further. Additional testing may be needed to confirm the results, and to help plan the treatment.

Which Hormonal Tests Are Performed In Male?

Hormonal levels such as,

• Testosterone Level.
• Follicle-Stimulating Hormone (FSH).
• Luteinizing Hormone (LH).
• Prolactin And Thyroid Hormone Levels(when indicated)

Hormonal abnormalities can impair sperm production and male reproductive function. Identifying and treating these hormonal disorders may improve fertility

What Are The Causes Of Unexplained Infertility?

Unexplained infertility is diagnosed when standard infertility investigations, including assessment of ovulation, semen analysis, tubal patency, and uterine cavity evaluation, are normal, yet pregnancy does not occur.

The exact cause is often unknown and may involve subtle abnormalities in gamete function, fertilization, embryo development, implantation, or other reproductive processes that cannot be detected by routine diagnostic tests.

Management options include expectant management (in selected couples), ovulation induction with or without intrauterine insemination (IUI), and in vitro fertilization (IVF), depending on the couple’s age, duration of infertility, and other clinical factors.

When Should You Consult a Gynaecologist?

You should consult a gynaecologist or fertility specialist if:

• You have been unable to conceive after 12 months of regular, unprotected intercourse (or 6 months if the female partner is 35 years or older).
• You have irregular or absent menstrual periods.
• You have experienced recurrent miscarriages.
• You have severe pelvic pain, suspected endometriosis, or any other concerns related to your reproductive health.
• Either partner has a known risk factor for infertility.

Early evaluation is essential, as it helps identify the underlying cause of infertility, determine whether it is reversible, and facilitate timely and appropriate treatment.

Infertility is a condition that may involve either the male or the female partner; therefore, both partners should be evaluated simultaneously. A comprehensive infertility evaluation includes a detailed medical history, physical examination, and appropriate laboratory and imaging investigations to establish an accurate diagnosis and formulate an individualized treatment plan.

Couples experiencing difficulty conceiving should seek medical advice from a gynaecologist or fertility specialist without unnecessary delay. Early diagnosis and treatment can significantly improve the chances of achieving a healthy pregnancy.