Fertility evaluation
A fertility evaluation is a planned set of conversations, scans and tests that looks for the reason conception is taking time. At EVE Women and Fertility Clinic in Gunjur, Bangalore, Dr. Swati Shree evaluates both partners together, so that any treatment starts from a clear diagnosis and not from a guess.
At a glance
- Who needs it
couples who have not conceived after 12 months of trying, or 6 months if the woman is 35 or older, or sooner with irregular periods or known problems
- What it covers
history, examination, ovulation, ovarian reserve, tubes, uterus and the male partner's semen
- Time
usually one to two menstrual cycles
- Both partners
the male partner's semen analysis is one of the first tests
- At EVE
consultation, ultrasound with antral follicle count, blood tests, tubal check and semen analysis, planned in order
- Result
a written summary and a plan you can understand and question
What a fertility evaluation looks for
- Conception needs five things to work
- an egg that is released (ovulation), healthy sperm, open fallopian tubes, a healthy uterus and lining, and the right timing. The evaluation checks each of these.
| Question | How it is checked |
|---|---|
| Are you ovulating regularly? | Cycle history, follicle tracking, mid-luteal progesterone, thyroid and prolactin tests |
| How many eggs are left (ovarian reserve)? | AMH blood test and antral follicle count on ultrasound |
| Are the fallopian tubes open? | HSG, or a saline contrast ultrasound; laparoscopy in selected cases |
| Is the uterus normal? | Pelvic ultrasound; 3D scan or hysteroscopy if needed |
| Is the semen normal? | Semen analysis, read against WHO reference limits |
| Any hormone problem? | Blood tests such as FSH, LH, estradiol, TSH, prolactin, as advised |
What happens at EVE
A long first consultation
Dr. Swati asks about cycles, past pregnancies, surgery, infections, medicines, work, sleep, stress, diet and habits, for both partners.
Examination and ultrasound
A transvaginal scan checks the uterus and ovaries and counts antral follicles. It is explained first and done with your consent, in privacy.
Blood tests
Some are done on specific cycle days. Dr. Swati tells you which and why.
Semen analysis
The male partner gives a sample after 2 to 7 days of abstinence, as the WHO manual advises.
Tubal check
An HSG is usually done after your period ends and before ovulation. See the HSG page.
Review and plan
You return to review the results together. Dr. Swati explains what is normal, what is not, and what the options are.
How to prepare
- Come together, and bring all earlier reports
- Note the first day of your last three periods
- Bring your medicines and supplements
- Avoid sexual intercourse for 2 to 7 days before the semen sample, as advised
- Do not self-start any fertility medicines before the evaluation
What the evaluation cannot do
Even after full testing, about one in four to one in three couples have no cause found. This is called unexplained infertility and is common. It does not mean nothing can be done. Timed attempts, IUI or IVF are options that Dr. Swati can explain.
FAQs
What tests are done in a fertility evaluation?
Usually a pelvic ultrasound with an antral follicle count, an AMH blood test, thyroid and prolactin tests, a tubal check such as HSG, and a semen analysis. Additional hormone tests or a hysteroscopy are added only if your history suggests them.
How long does a fertility evaluation take?
One to two menstrual cycles in most cases, because some tests must be done on certain cycle days. The first consultation is the longest visit, and you may need two or three short visits after that.
Do both partners need to be tested?
Yes. A male factor is the main or a contributing cause in about half of couples. A semen analysis is simple, inexpensive and one of the first tests. Evaluating only the woman can delay the diagnosis by months.
Is a fertility evaluation painful?
Most of it is a conversation, blood tests and a scan. A transvaginal ultrasound may feel uncomfortable but is quick. An HSG can cause cramps for a short time. Dr. Swati explains each step first and pauses if you ask.
What if all my tests are normal?
Normal tests mean there is no clear cause, which is called unexplained infertility. It is common. Timed attempts with monitoring, IUI and IVF are options. Dr. Swati reviews your age and time trying to suggest the next step.
When should I get tested?
After 12 months of trying, or 6 months if the woman is 35 or older. Get tested sooner if periods are very irregular, if you have endometriosis, fibroids, tubal disease or a past pelvic infection, or if the male partner has a known problem.
Sources
- ASRM Practice Committee, Definition of infertility (2023) and Evaluation of the infertile female (2015)
- ESHRE Guideline: Unexplained infertility (2023)
- NICE Guideline CG156: Fertility problems: assessment and treatment
- WHO laboratory manual for the examination and processing of human semen, 6th edition (2021)
