When Should Fertility Tests Be Done?
| Your Age | When to See a Specialist |
|---|---|
| Under 35 | After 12 months of regular unprotected intercourse without pregnancy |
| 35 and over | After 6 months — don't wait a full year |
| 40 and over | Book a consultation before you start trying, or immediately |
| Any age | If you have irregular periods, a known condition (PCOS, endometriosis, thyroid disease), or a previous miscarriage — earlier investigation is appropriate |
Complete Female Fertility Workup — The Tests Explained
1. Ovarian Reserve Assessment — How Many Eggs Do You Have?
AMH (Anti-Müllerian Hormone)
- Simple blood test — can be done on any day of the cycle
- Measures the hormone produced by small follicles in the ovaries — gives an indication of the remaining egg pool
- Low AMH = smaller reserve — time is more pressing
- High AMH = large pool of follicles (often seen in PCOS)
AFC (Antral Follicle Count)
- Done by transvaginal ultrasound on day 2–3 of the cycle
- The doctor counts the small follicles visible in both ovaries
- Directly reflects available egg reserve
FSH and LH (Day 2–3 Blood Test)
- FSH above 10 mIU/mL suggests declining ovarian reserve
- The LH:FSH ratio helps in diagnosing PCOS
2. Hormonal Panel
| Test | What It Checks |
|---|---|
| TSH | Thyroid function — critical for fertility and pregnancy |
| Prolactin | Elevated prolactin blocks ovulation |
| Testosterone, DHEAS | Androgen levels — PCOS assessment |
| Fasting insulin + glucose | Insulin resistance |
| Estradiol (day 2–3) | Baseline oestrogen level |
3. Uterus and Fallopian Tube Assessment
Transvaginal Ultrasound (TVS) — The standard first-line imaging. Assesses:
- Uterine shape, size, and lining
- Ovaries and follicle count
- Presence of fibroids, polyps, or cysts
HSG (Hysterosalpingography)
- Done on day 7–10 of the cycle (after period, before ovulation)
- An X-ray with contrast dye injected through the cervix — shows whether the fallopian tubes are open
- If dye doesn't spill through the ends of the tubes — blockage suspected
- This test is important and should not be skipped without good reason
3D Ultrasound or Saline Infusion Sonography (SIS) — Provides detailed assessment of the uterine cavity — useful for detecting polyps, a uterine septum, or submucosal fibroids.
Hysteroscopy — A camera inserted directly into the uterine cavity — the gold standard for evaluating the cavity. Can diagnose and treat in the same procedure.
Laparoscopy — Camera into the pelvis — identifies endometriosis, adhesions, and tube problems that other tests may miss.
4. Infectious Disease Screening
- Rubella immunity: If not immune, vaccinate before conceiving
- Thyroid antibodies: Autoimmune thyroid assessment
- STI screening (Chlamydia particularly): Often silent, but can cause significant tube damage
5. Partner's Semen Analysis — Equally Important
Male factor accounts for 35–40% of infertility. Testing the woman comprehensively while skipping the male partner is only half a picture.
A semen analysis (count, motility, morphology) should always be done alongside the female workup. In many cases, adding DFI (DNA fragmentation) and CASA provides a much more complete picture.
When Should Each Test Be Done?
| Test | Timing | Reason |
|---|---|---|
| AMH, Prolactin, TSH | Any day of cycle | Not cycle-dependent |
| FSH, LH, Estradiol, AFC | Cycle day 2–3 | Baseline hormonal status |
| HSG | Cycle day 7–10 | After period, before ovulation |
| Progesterone | Day 21 (in a 28-day cycle) | Confirms ovulation occurred |
| Fasting glucose and insulin | Morning fasting | Metabolic assessment |
Get a Clear Picture of Your Fertility
A structured fertility workup gives you information, not a verdict — and the earlier you have it, the more options you keep. Consult Dr. Dipesh Sorathiya at Khushhi IVF, Thaltej, Ahmedabad to plan the right tests for your situation.
Book an Appointment Learn About the ClinicNumbers Are Not the Whole Story
The same AMH result of 0.8 ng/mL carries very different implications for a 30-year-old versus a 38-year-old. Numbers need to be interpreted in the context of your age, symptoms, your partner's results, and the clinical picture overall.
Do not try to interpret your fertility test results alone from an internet search. Bring them to your doctor and have a full conversation about what they mean for your specific situation.
Frequently Asked Questions
Does low AMH mean I can't get pregnant?
No. AMH is an indicator of ovarian reserve, not an absolute predictor of fertility. Many women with low AMH conceive — naturally or through IVF. What low AMH does mean is that time matters more for you, so acting sooner rather than later is wise.
Is an HSG painful?
Some women feel mild discomfort similar to period cramps. Others experience more significant pain. Your doctor can prescribe a painkiller before the procedure. It is brief — usually 5–10 minutes.
Do I need all these tests at once?
No. Your doctor will order tests based on your age, symptoms, and history. A structured, systematic approach is better than ordering everything simultaneously.
What does fertility testing cost in India?
AMH: approximately ₹1,500–3,000; HSG: ₹2,000–4,000; full hormonal panel: ₹3,000–6,000. Costs vary between clinics and cities.
Khushhi IVF 5th Floor, Soham Pristine, Off Sindhubhavan Road, Thaltej, Ahmedabad, Gujarat 380054, India.
