Female Fertility Evaluation — The Comprehensive Workup
In short — A complete fertility workup covers ovarian reserve, the uterine cavity and tubes, ovulation and thyroid function, and a semen analysis for the partner. The purpose is to identify what is treatable before treatment is chosen, so that IVF is a considered step rather than a default.
A complete female fertility evaluation establishes ovarian reserve, ovulatory function, uterine cavity and tubal status, and identifies modifiable factors. This page describes the structured workup performed before any IVF or assisted conception decision — aligned with ESHRE (2023), ASRM (2020–2024) and NICE (2026) guidance.
1. Detailed clinical history
Menstrual history (cycle length, regularity, pain, flow), obstetric history, sexual and contraception history, surgical history (especially pelvic surgery), family history of premature ovarian insufficiency or endometriosis, medical conditions (thyroid, diabetes, PCOS, autoimmune), lifestyle (weight, smoking, alcohol, exercise, stress, sleep), and partner factors. A careful history from both partners guides which tests are needed.
2. AMH — anti-Müllerian hormone
AMH reflects the size of the remaining follicle pool. Random blood test, no cycle-day requirement. It is interpreted against age- and laboratory-specific ranges, because results differ between assays. AMH predicts IVF response (number of eggs retrieved) better than it predicts pregnancy chance.
3. Antral follicle count (AFC)
Transvaginal ultrasound counting follicles 2–10 mm in both ovaries, performed in early follicular phase (cycle day 2–5). AFC is read together with age and AMH: a low count suggests fewer eggs, and 20 or more follicles in one ovary suggests polycystic ovaries. AFC and AMH together provide the most accurate ovarian reserve picture.
4. Day 2–3 hormone profile
A normal FSH does not rule out low ovarian reserve; AMH and AFC predict the response to stimulation better than FSH or estradiol. LH evaluated for PCOS pattern. TSH is read against the laboratory’s own reference range; current ASRM guidance (2024) does not recommend levothyroxine for subclinical hypothyroidism in women trying to conceive, as it has not been shown to improve pregnancy or live-birth rates. Prolactin is checked when cycles are irregular or there are symptoms such as nipple discharge; ESHRE (2023) does not recommend routine prolactin testing in unexplained infertility.
5. Uterine cavity assessment
Transvaginal ultrasound assesses general cavity, myometrial thickness, fibroids, polyps. Saline-infusion sonography (SIS) — an accurate, less invasive assessment of the cavity; identifies sub-mucous fibroids, polyps, adhesions, congenital anomalies. Hysteroscopy — the reference standard, used for diagnostic confirmation, surgical correction, or chronic endometritis biopsy in selected cases.
6. Tubal patency assessment
Hysterosalpingography (HSG) — radiographic test of tubal patency, also assesses cavity. HyCoSy (saline-infusion sonography with foam contrast) — ultrasound-based alternative, avoids radiation. Laparoscopy with dye (chromopertubation) — the reference test for the tubes, used when pelvic disease is suspected or surgery is likely. Hydrosalpinx identified must be addressed before IVF (clipping or salpingectomy).
7. Expert pelvic ultrasound for endometriosis
ISUOG IDEA consensus protocol — systematic transvaginal ultrasound mapping for endometriosis. Identifies endometriomas, deep infiltrating disease, ovarian mobility (kissing-ovaries sign), pouch of Douglas obliteration. Critical for fertility-seeking patients because endometriosis affects ovarian reserve, embryo quality and implantation.
8. Additional tests in selected cases
Testing for chronic endometritis (CD138 on an endometrial biopsy) can be considered after repeated implantation failure. In recurrent pregnancy loss, karyotyping both partners is advised after individual assessment — for example, when testing of pregnancy tissue shows an unbalanced rearrangement — and it can be considered after repeated implantation failure. Antiphospholipid antibodies after two or more pregnancy losses, or after implantation failure when there are risk factors for thrombophilia. Inherited thrombophilia testing only with a personal or family history of thrombosis. Sperm DNA fragmentation testing is not recommended when the semen analysis is normal, but can be considered in recurrent pregnancy loss. Genetic carrier screening for selected ancestries.
The comprehensive workup
| Domain | Tests |
|---|---|
| Ovarian reserve | AMH, antral follicle count |
| Uterus | Scan, cavity assessment |
| Tubes | Where relevant |
| Male | Semen analysis |
Our IVF practice follows international reproductive-medicine standards.
Frequently Asked Questions
What does the female fertility workup involve?
Is AMH a measure of egg quality?
What if my AMH is low?
Do I need HSG or HyCoSy?
How long does the evaluation take?
Is laparoscopy needed for diagnosis?
What about recurrent miscarriage workup?
How does evaluation differ for unexplained infertility?
Dr Patel leads fertility care at Balaji Horizon, integrating reproductive surgery and IVF into a single plan — ethical, evidence-based and individualised, with realistic expectations and no overpromising of success.
Individualised IVF and fertility planning with honest, evidence-based counselling — and realistic expectations from the very first consultation.
Dr. Priyadatt Patel
Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead
MS OBGyn · Pregnancy Care · Advanced Gynaecological Ultrasound · Fertility Preservation
ESHRE / ESGE / AAGL / ASRM guideline-aligned practice. 3D Karl Storz precision technique. Fertility-preservation-first philosophy. Evidence-based decisions, honest counselling, long-term outcomes orientation.
323, Satyamev Eminence, Beside Saptak Bungalows & AUDA Water Tank, Science City Road, Sola, Ahmedabad 380060
Open 24 hours (emergencies & labour) · OPD Mon–Sat 11:00–20:00 · +91 97234 31544
Naranpura, Ahmedabad
Mon–Sat 08:30–10:30 · +91 70460 02566
