By Dr. Shweta Agarwal, MBBS, DGO Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO Last updated: June 2026
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
Aansh Hospital & IVF Center is a government-registered Level-2 ART clinic (Reg. No. MH/AC/2024/15441/L2/Chandrapur/132), part of a growing chain of fertility centres across Vidarbha and northern Telangana, with our headquarters and in-house embryology lab in Chandrapur. You can verify our government ART registration directly on the National ART & Surrogacy Registry.
Couples who come to a fertility clinic for the first time often expect the investigation to focus on one partner — usually the woman. What they quickly discover is that a complete fertility workup always investigates both partners simultaneously. This is not bureaucratic thoroughness; it is basic clinical logic.
The data on this is consistent: when a cause of infertility is eventually identified, it is a female factor alone in roughly one-third of cases, a male factor alone in roughly one-third, and a combination of both — or unexplained after full investigation — in the remainder. These are general population figures drawn from published fertility research, not clinic-specific statistics. The implication is straightforward: an investigation that starts with only the female partner will miss or delay the diagnosis in at least half of all couples.
This post is a map of the whole workup — what each test checks, when it needs to be done in the cycle, and what the results lead to. Each test described here has its own dedicated post or page for those who want the detail; this overview is designed to help you understand how the pieces fit together before your first fertility consultation and before you arrange a fertility checkup.
The Marathi phrase for fertility tests is प्रजनन चाचण्या (prajanan chachanya) — literally "reproductive investigations." The workup described below is what those investigations involve in practice.
Why are both partners tested at the same time?
Testing both partners simultaneously is the most efficient and clinically sound approach to investigating a couple who have not conceived. Because male factor is involved in roughly half of all presentations — either alone or alongside a female factor — deferring the male investigation means deferring the diagnosis for a significant proportion of couples.
There is a second practical reason: the results interact. If semen analysis shows a significant male factor finding, the female workup findings determine together with that result whether IUI is a realistic option or whether IVF with ICSI is more appropriate from the outset. You cannot make that determination with only one side of the picture.
Testing both partners also avoids the common experience of spending months on female investigations and treatment before discovering that a male factor has been present throughout. For a detailed discussion of what both partners can expect at the first appointment, see What to Expect at Your First Fertility Consultation.
At Aansh, the standard approach is to plan the initial investigations for both partners at the first consultation and to review all results together at a follow-up appointment before discussing a treatment plan.
What does the female fertility workup include?
The female workup is designed to answer four clinical questions: Is ovulation occurring? What is the ovarian reserve? Is the uterus and are the fallopian tubes structurally normal? Are there hormonal factors contributing?
The investigations are as follows.
Transvaginal ultrasound (TVS)
A baseline transvaginal ultrasound — ideally timed around Day 2–5 of the menstrual cycle or as a structural assessment at any point — is typically the first imaging investigation. It assesses the uterus (size, shape, endometrial lining, presence of fibroids or polyps), both ovaries (size, structure, presence of cysts), and the antral follicle count (AFC). AFC is a direct count of small resting follicles visible on ultrasound and is one of the two main markers of ovarian reserve, alongside AMH.
Ovarian reserve assessment (AMH + AFC)
AMH (anti-Müllerian hormone) can be measured from a blood draw on any day of the cycle — it does not require cycle timing. It reflects the pool of remaining small follicles and is used alongside AFC to estimate ovarian reserve: how many eggs remain available. AMH measures quantity, not egg quality. The two markers together provide a more reliable reserve picture than either alone. For a detailed explanation of what low AMH means and what it does not mean, see the dedicated post What Is AMH? What a Low AMH Level Means for Fertility.
Day 2–3 hormonal panel (FSH, LH, oestradiol)
Follicle-stimulating hormone (FSH), luteinising hormone (LH), and oestradiol are measured on days two to four of the menstrual cycle — specifically during the early follicular phase, when these hormones should be at their baseline levels. Elevated FSH suggests reduced ovarian reserve, as the pituitary is signalling harder to drive follicle development. The FSH/LH ratio can provide additional information, including an indication of PCOS-related ovulatory dysfunction. Oestradiol is measured alongside FSH because a suppressed oestradiol can artificially normalise an FSH reading that would otherwise be elevated.
Prolactin
Prolactin is measured as part of the hormonal panel because elevated prolactin (hyperprolactinaemia) can suppress ovulation and cause irregular or absent periods. It is a common and treatable cause of ovulatory disorder. Prolactin can be measured on any cycle day and does not require cycle timing, though it is usually included with the Day 2–3 draw for convenience.
Thyroid function (TSH)
Thyroid-stimulating hormone (TSH) is routinely measured because both hypothyroidism and hyperthyroidism can affect ovulation, cycle regularity, and implantation. Thyroid disease is common, often asymptomatic, and straightforwardly treated. TSH can be drawn on any day.
Ovulation assessment (mid-luteal progesterone)
To confirm that ovulation is actually occurring in a given cycle, a serum progesterone measurement is taken in the mid-luteal phase — approximately Day 21 in a standard 28-day cycle, adjusted for cycle length if cycles are longer or shorter. A progesterone level above a threshold consistent with ovulation confirms that ovulation occurred in that cycle. This is a direct biological confirmation, not just an estimate from cycle history or LH tracking.
Tubal patency assessment (HSG or HyCoSy)
The fallopian tubes carry the egg from the ovary to the uterus and are the site where fertilisation naturally occurs. If both tubes are blocked, natural conception and IUI are not possible, and the diagnosis has direct implications for treatment planning. Hysterosalpingography (HSG) is an X-ray procedure in which contrast dye is introduced through the cervix and its passage through the uterine cavity and tubes is imaged. HyCoSy (hysterosalpingo-contrast sonography) achieves the same assessment using ultrasound with contrast rather than X-ray.
Both procedures check: (1) whether each fallopian tube is open (patent) to the flow of contrast; and (2) the shape and contour of the uterine cavity, which can reveal polyps, fibroids, or structural anomalies not visible on routine ultrasound. HSG also provides information about tubal outline that can suggest the presence of hydrosalpinx (fluid-filled blocked tubes) or peritubal adhesions.
Tubal assessment is typically arranged after the initial blood tests and ultrasound are reviewed — not at the first visit — because the results of the earlier investigations may affect which procedure is most appropriate and how urgently it is needed.
Hysteroscopy or laparoscopy (when indicated)
Direct telescopic inspection of the uterine cavity (hysteroscopy) or the pelvic cavity (laparoscopy) is not a first-line investigation but may be recommended when there are specific findings — for example, a suspected uterine septum, endometrial polyp, or unexplained cavity anomaly on HSG; or when endometriosis is suspected from symptoms and ultrasound findings. These are targeted, not routine.
What does the male fertility workup include?
The male fertility workup starts with one investigation: semen analysis. It is the first-line test, the least invasive, and the most informative starting point for understanding the male contribution to a couple's fertility picture.
Semen analysis (first-line)
A semen analysis examines sperm count (concentration), motility (movement — total and progressive), morphology (shape), semen volume, pH, and vitality. The World Health Organization's Laboratory Manual (6th edition, 2021 — WHO 2021) provides the current reference values for each parameter. For a detailed explanation of what each parameter means, how to read the report, and what oligospermia, asthenozoospermia, and azoospermia mean clinically, see Semen Analysis Results Explained: What the Numbers Mean.
One result is never interpreted in isolation. If parameters are outside the reference range on a first analysis, a repeat sample — collected after two to five days of abstinence, at least four to six weeks later — is standard before drawing conclusions. Semen parameters fluctuate in response to recent illness, fever, stress, and lifestyle factors.
At Aansh, semen analysis is performed in our in-house andrology lab by Aayush Agarwal, our senior clinical embryologist, under WHO-standard conditions. Results are typically available the same day and are handled with complete confidentiality.
Further male investigations (when indicated)
If semen analysis results are significantly abnormal or if there is clinical reason to investigate further, the workup may extend to:
- Hormonal panel (FSH, LH, testosterone, prolactin) — to determine whether the cause is testicular or originates higher in the pituitary signalling pathway, and to distinguish obstructive from non-obstructive causes in azoospermia.
- Scrotal ultrasound — to assess testicular volume, identify varicocele (enlarged testicular veins, a treatable cause of poor semen parameters), and examine the epididymis.
- Sperm DNA fragmentation test — not a standard semen analysis parameter, but recommended in selected cases: unexplained infertility despite normal or borderline parameters, recurrent early pregnancy loss, or repeated implantation failure in IVF.
- Genetic testing (karyotype and Y-chromosome microdeletion analysis) — primarily for severe oligospermia (very low count) and azoospermia (no sperm found), where genetic causes are more likely.
These further investigations are not ordered routinely — they are triggered by the semen analysis findings and the clinical picture. The pathway is always individualised.
Which tests are cycle-day specific, and how does timing work?
Understanding which tests require specific timing in the menstrual cycle is practically important, because it affects how quickly the full workup can be completed.
Cycle-day specific (require timing to the menstrual cycle):
- Day 2–3 hormonal panel (FSH, LH, oestradiol) — must be drawn in the early follicular phase.
- Baseline transvaginal ultrasound for AFC — ideally Days 2–5, though a structural assessment can be done at any point.
- Mid-luteal progesterone — approximately Day 21 in a 28-day cycle, adjusted for actual cycle length.
- HSG/HyCoSy — typically scheduled in the first half of the cycle (after the period has ended but before ovulation), to avoid radiation exposure to a potential early pregnancy and to allow clear visualisation of the cavity.
Not cycle-day specific (can be done at any time):
- AMH blood test.
- Prolactin.
- TSH (thyroid function).
- Semen analysis (though consistent abstinence of two to five days is required before the sample).
At a first consultation, the clinical team will map out which investigations are needed for your specific situation and match them to your upcoming cycle to minimise total time. In practice, most of the core workup can be completed within one to two menstrual cycles.
What do the results lead to?
The purpose of the workup is to move from "trying without success" to "a diagnosis with a treatment plan." Results from the investigations above typically lead to one of several clinical directions.
Evidence of ovulatory disorder (irregular cycles, low mid-luteal progesterone, elevated LH/FSH ratio) points toward conditions such as PCOS or hypothalamic amenorrhoea. These may be addressed with ovulation induction before or instead of IUI or IVF. See the PCOS conditions page for more context.
Reduced ovarian reserve (low AMH, low AFC, elevated FSH) affects the urgency and the IVF stimulation strategy. It does not prevent pregnancy, but it does change how protocols are planned and how many cycles may be needed.
Structural findings (blocked tube, uterine polyp, fibroid, or cavity anomaly) may require a targeted procedure before fertility treatment can proceed effectively.
Significant male factor (low count, poor motility, or azoospermia) shapes whether IUI is a realistic option or whether IVF with ICSI is more appropriate from the outset. Azoospermia requires a separate investigation pathway.
Unexplained infertility — when the full workup returns within normal limits for both partners — is a recognised clinical category. It is not a dead end; it guides treatment decisions toward empirical approaches or, depending on duration of trying and age, directly to IVF. Results that are technically within reference range but borderline may still have clinical significance when viewed together.
All of these interpretations are made in the context of the couple's full picture — duration of trying, age, prior pregnancies, and any prior treatment. The same result set in two different couples can lead to quite different recommendations.
How should you prepare before your first fertility workup?
Coming to your first consultation with some basic information already gathered makes the appointment more productive and reduces the time before a clear picture emerges.
For the female partner: note your average cycle length and any irregularity, the character of your periods (particularly any significant pain, which may indicate endometriosis — see the endometriosis conditions page), and whether you have used ovulation tracking. If you have had any prior fertility tests, blood results, or ultrasound reports, bring them.
For the male partner: if you have had a prior semen analysis at any point, bring the report. Note any relevant history — prior surgeries in the groin or scrotal area, history of mumps after puberty, any known hormonal issue.
Both partners: bring a list of current medications (including supplements and thyroid medication), and a government-issued photo ID. Government-issued ID is a standard ART Act documentation requirement.
For the full list of what to bring and what to expect at the first appointment, see What to Expect at Your First Fertility Consultation.
If you are not yet ready for a full consultation but want to start with a structured overview of your reproductive health, the fertility checkup is designed as a practical first step.
What is the difference between a fertility checkup and a full workup?
A fertility checkup is a structured entry-level assessment — a targeted set of core tests that give an initial picture of fertility health for both partners. It typically includes AMH, a baseline ultrasound, and a semen analysis, providing the most clinically significant first data points without committing to the full investigation at once.
A full fertility workup is a comprehensive, individualised investigation ordered after a consultation, where the clinical history is taken and the tests are planned specifically for the couple's situation. It includes all the investigations described in this post — or a subset of them, depending on what the history suggests is most important to investigate first.
The two are not alternatives — they are typically sequential. Many couples start with a fertility checkup to get early data, then move to a full consultation and complete workup once the initial results are reviewed. Both are available at Aansh without a referral; you can book directly by WhatsApp or by calling +91 80056 85160.