Infertility Assessment and Tests | Prof. Dr. İkbal Kaygusuz

Infertility Assessment: Which Tests Are Done?

Prof. Dr. İkbal Kaygusuz Last reviewed: 25 September 2026 2 min read

In short: Infertility means no pregnancy after one year of regular intercourse (six months if the woman is 35 or over). Both partners are assessed: ovulation, ovarian reserve, tubes and uterus in the woman and semen analysis in the man. Most tests can be completed within one menstrual cycle.

When should infertility be considered?

About 80-85% of healthy young couples conceive within the first year. Assessment is therefore recommended after one year for women under 35 and after six months from 35. Seek advice earlier if you have irregular periods, known endometriosis, previous pelvic surgery or infection, are over 40, or your partner has a known sperm problem.

Tests for the woman

Ovulation

Most women with regular periods ovulate. Progesterone about a week before the period can confirm ovulation. With irregular cycles, thyroid hormones, prolactin and polycystic ovary syndrome are assessed.

Ovarian reserve

AMH (anti-Müllerian hormone) and the antral follicle count on early-cycle ultrasound estimate the remaining egg supply. They do not predict pregnancy on their own but guide treatment planning.

Tubes and uterus

Tubal patency is checked by hysterosalpingography (HSG) or foam ultrasound. Polyps, fibroids or adhesions inside the uterus are assessed by transvaginal ultrasound and, if needed, hysteroscopy.

Tests for the man

The key test is a semen analysis after 2-5 days of abstinence, assessing sperm count, motility and shape. Abnormal results are repeated after a few weeks and referred for urological assessment. A male factor contributes to about a third of cases.

What is unexplained infertility?

When all standard tests are normal but pregnancy does not occur, the infertility is called unexplained. This applies to about a quarter of couples. Depending on age and duration, expectant management, insemination or IVF are considered.

After the assessment

Results are reviewed together to create a plan for the couple, ranging from ovulation medication and insemination to surgery or IVF when needed. Weight management, stopping smoking and folic acid are recommended at every stage.

Frequently Asked Questions

On which day of the cycle are fertility tests done?

Hormone tests (FSH, LH, oestradiol) and the antral follicle count are usually done on day 2-3. AMH can be measured on any day. HSG is done after the period ends and before ovulation.

Can I still conceive with low AMH?

Low AMH means fewer eggs remain but does not by itself determine egg quality or the chance of natural pregnancy. Pregnancy is possible with low AMH, especially in younger women.

How should I prepare for a semen analysis?

Abstain for 2-5 days. Provide the sample by masturbation into a sterile container and deliver it to the laboratory within an hour.

Sources

NICE Guideline CG156: Fertility problems: assessment and treatment.
ASRM Practice Committee. Fertility evaluation of infertile women: a committee opinion. Fertil Steril, 2021.
ESHRE Guideline: Unexplained infertility, 2023.

The information on this website is for general information only and does not replace a medical consultation.

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