Who needs evaluation?
A couple who have been together for a year without use of any contraception, needs evaluation for infertility.
If there are other associated problems like PCOD, endometriosis, advanced age nearing 40, then earlier evaluation is required.
How do we go about?
Evaluation of the female includes:
Ovarian reserve:
Normally, a female baby has an average of 1-2 million eggs at birth, it gradually reduces to 4,00,00 eggs around the time of puberty. As age advances the number and quality of eggs starts to diminish. Ovarian reserve can be tested by blood tests and ultrasound scanning.

Blood tests: AMH or anti-mullerian hormone is a test done for ovarian reserve. It can be done on any day of the cycle and no fasting required
FSH: done on day 2 of the menstrual cycle
Ultrasound scanning is done on day 2 of the cycle: to count the number of eggs or AFC count {antral follicle count}. It doesn’t signify the quality of the eggs.
In general, Ovarian reserve test tells us about the quantity of eggs and your chance of response with medications. Lower the reserve, poorer will be the response to treatment. High FSH, low AMH or low AFC counts on scanning suggests reduced ovarian reserve.
Tubal test:
A methylene blue dye is diluted and injected via the cervix, and the tubal spillage of dye is detected.
Can be done by:
- HSG or hysterosalpingogram– it is done post-menstrually as a day-care procedure. A series of X rays are taken to detect the passage of dye through the uterus and fallopian tube.
What to expect?
- Vaginal examination and speculum is inserted. A cannula is inserted into the cervix and dye is injected. It can be associated with severe cramps and will require good analgesia for a day.

- Laparoscopy: After giving general anaesthesia, laparoscopy is inserted, and the dye injected from the cervix will be directly seen using camera.
What to expect?
- Done under general anaesthesia and will not experience pain during procedure. Small incisions over the abdomen. Doesn’t require bed rest.
- Preferable if simultaneous drilling of the ovary is required or simultaneous treatment of tubal block needs to be done.

- Hycosy/ sonosalpingogram: If facility is available, the saline is injected via the cervix and simultaneously, ultrasound is done to detect fluid filling the abdomen.

Evaluation of the uterus
Ultrasound pelvis: Is done to detect any uterine anomalies, fibroid, adenomyosis, etc.
In complicated cases, MRI pelvis or 3D ultrasound scanning may be required.

Husband factor:

Semen analysis is required to be done as a basic evaluation of of the couple.
It has to be done after 3-4days of abstinence from intercourse.
It checks for the quantity, motility and structure of the sperms

As per the WHO criteria, sperm concentration less than 15million per ml of semen, progressive motility less than 32% and morphology less than 4% are considered abnormal.
Ultrasound of the scrotum: may be required in case of reduced sperm counts to look for any varicocele or any local factors.
Hormonal evaluation of the husband: FSH, LH, testosterone may be required when the sperm quantity is grossly disturbed.