Fertility Tests for Couples: What to Expect at Your First Assessment

By Dr. Anshika Lekhi | MBBS, DGO, Fellowship in Reproductive Medicine, The Fertilife, Gurgaon

Do you feel nervous about walking into your first fertility consultation? Most people do, and it is usually because they are not sure what exactly is going to be assessed, what the tests actually involve, or how much time all of it is going to take. At The Fertilife we believe that having some clarity before you arrive makes the whole process significantly less stressful for you. Our Fertility Tests for couples are structured as a joint assessment right from the very beginning, and the reason for this is that in approximately 40 to 50% of infertility cases, a contributing male factor is identified, which makes it essential that both partners are evaluated at the same time rather than one after the other.

What Happens at Your First Consultation?

Before a single test is ordered, Dr. Anshika Lekhi goes through a detailed review of your medical and reproductive history. This includes the following:

• How long the two of you have been trying to conceive, and how regular your cycles are

• Any previous pregnancies, any losses, and any fertility treatment you have had before

• Medical conditions which are relevant to fertility, such as thyroid disorders, PCOS, endometriosis and diabetes

• Your surgical history, and particularly any abdominal or pelvic procedures

• Medications, lifestyle factors and any occupational exposures

This history is given priority because it is what shapes which of the tests are most relevant for your specific situation. Not every couple needs every single test, and moreover a good diagnostic workup is a targeted one rather than a standard list which gets applied uniformly to everybody.

What Does the Female Assessment Cover?

Ovarian Reserve Testing

Ovarian reserve reflects the quantity, and to some degree the quality, of the eggs which are remaining in your ovaries. It gets assessed through the following:

• AMH (Anti-Müllerian Hormone): A blood test which can be taken on any day of your cycle. AMH is the single most reliable marker of ovarian reserve and it directly influences how a stimulation protocol is going to be designed for you

• Antral Follicle Count (AFC): A transvaginal ultrasound which counts the small follicles that are visible in both of your ovaries. It is typically performed between Days 2 and 5 of the menstrual cycle

Hormonal Profile

A Day 2 or Day 3 blood panel includes FSH, LH and estradiol, which are the hormones reflecting how your pituitary gland is signalling the ovaries. An elevated FSH is associated with diminished ovarian reserve, whereas the LH and estradiol levels help in characterising the hormonal environment at the start of your cycle.

Moreover, there are additional hormonal tests which get added depending on your history:

• Thyroid function, meaning TSH, free T3 and T4, as thyroid disorders are a common cause of ovulatory dysfunction and a treatable one as well

• Prolactin, because elevated levels of it can suppress your ovulation

• Fasting insulin and glucose, which become relevant wherever PCOS or metabolic issues are suspected

Uterine Assessment

A transvaginal ultrasound evaluates your uterine cavity for fibroids, polyps or any structural abnormalities. Wherever that initial ultrasound raises a concern, a saline infusion sonography, which is called SIS, or a hysteroscopy may follow after it. The patency of your fallopian tubes is assessed through a hysterosalpingography, or HSG, which is an X-ray procedure where a contrast dye is passed through the tubes, and this is done wherever the clinical picture indicates it.

What Does the Male Assessment Cover?

Our Male Assessment begins with a comprehensive semen analysis, and this measures the following:

• The sperm count, meaning the concentration per millilitre

• Total motility, which is the percentage of moving sperm, along with progressive motility

• Morphology, which is the percentage of normally shaped sperm

• The volume, the pH and the liquefaction time

Wherever the basic semen parameters come back normal but the couple has a history of unexplained infertility, recurrent loss or failed cycles, a sperm DNA fragmentation index gets added on. This is what identifies the DNA damage which does not show up on a standard analysis but which can significantly affect how the embryo develops. A hormonal profile and a scrotal ultrasound are ordered wherever the semen analysis warrants further investigation.

How Long Does the Full Assessment Take?

The complete assessment, right from your first consultation through to the treatment recommendation, typically takes two to three weeks, and this depends on where exactly you are in your menstrual cycle at the time of your visit.

Your Patient Journey From Here

Our Patient Journey at The Fertilife does not come to an end at the results appointment. Once all of the findings are available, Dr. Anshika Lekhi walks you through each result in detail, explains what they mean both individually and together, and then presents a treatment recommendation along with the clear reasoning behind it. The costs, the timelines and the realistic expectations are all discussed with you before any protocol begins.

Fertility Tests are not simply an administrative step which has to be got through. They are the foundation on which every treatment decision we make is built, and the more complete that picture is, the more precise your plan can be. To begin your Female Assessment or your Male Assessment at The Fertilife, visit thefertilife.in and book your first consultation today.

This article is for general educational purposes and is not a substitute for personalised medical advice from your fertility specialist or embryologist.