When infertility is suspected in a couple, investigations are carried out to determine the cause and plan appropriate treatments. For assessing male-related issues, the first step involves a semen analysis (sperm test) and a urological examination performed by a urologist. Further investigations may be scheduled by the urologist if necessary.

For females, the initial investigations typically include a pelvic examination, ultrasound, hormonal tests to assess ovarian function, and if needed, ovarian reserve tests. Additionally, a uterine X-ray (HSG) may be requested.

Pelvic examination and ultrasound:

These are the primary steps in evaluating infertility. They aim to identify any existing issues such as fibroids, cysts, polyps, or similar problems. The condition of the fallopian tubes cannot be observed through ultrasound; therefore, a uterine X-ray (HSG) is necessary for assessing their patency. Ultrasound can also monitor follicle (egg) growth and the presence of ovulation.

Hormonal tests:

These tests are essential in cases of infertility. Hormonal tests to evaluate ovarian function (FSH, LH, estrogen, progesterone) are typically conducted on the third day of the menstrual cycle. These tests provide important information about a woman’s ovarian reserve (ovarian capacity) and her chances of getting pregnant. Additionally, thyroid hormone levels, prolactin, complete blood count, blood type, hepatitis, and HIV tests are usually performed without the requirement of being on the menstrual cycle. If deemed necessary, the anti-Müllerian hormone (AMH) test may also be included. Progesterone hormone measurement on the 21st day of the menstrual cycle provides insights into the occurrence of ovulation.