Initial Couple Assessment, Workup And Diagnosis

Human conception is a delicate process. Of all the couples trying to conceive, about 84% will conceive in 1 year of trying, but only about additional 8% will conceive after trying naturally for one more year.  A wide range of fertility treatments are available these days which can assist couples in fulfilling their dream of parenthood.

More than 80% couples facing difficulty in conceiving will require simple methods like lifestyle modifications, counseling and simple oral medication. The rest may require Assisted Reproduction (AR), which means the clinical procedures where sperms & or eggs are handled outside the human body. AR may range from simply putting washed sperm inside the woman’s uterus to sophisticated high-end laboratory procedures like blastocyst culture and Laser Assisted Hatching (LAH).

It is therefore, crucial to assess individual couple’s fertility factors, pertaining to both the male and female partners, by means of thorough history taking and clinical examination. Further workup as per individual couple’s indications, helps in arriving at the diagnosis pertaining to reason(s) behind inability to conceive.

Initial Assessment of Infertility in Men:                                              

The assessment of male infertility depends on the factors and functioning of his organs like hypothalamus, pituitary gland and testicle. For this he has to go under some tests like physical examination and semen analysis. Also patient’s health history is also taken into consideration.

Physical examination includes measurement of height and weight which also includes examination of male genitals. Levels of testosterones are checked.

Patient’s history is included to examine whether he was gone under some medications or therapy or had a slow sexual development during puberty, if he suffered from any infections previously which would have lead to this condition. Sexual history of the patient is also asked.


Diagnosis is done with the following methods like:

Semen Testing: It is the main and very crucial procedure for diagnosis for men infertility.  Semen testing is done for the measurement of sperm count. In this analysis the number, motility and shape of the sperm are analyzed.

Blood test: Blood test gives the hormonal information of the male. This test is included for the diagnosis of testosterone levels, Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) and pituitary hormones.

Initial Assessment of Infertility in Female:

In females along with the medical history and physical examination, menstrual history is also considered as very important factor.

Female’s medical history includes the factors such as pre medical condition and treatment, slow sexual development in puberty, some allergies or infections or exposure to any other treatment.

Menstrual history: the patient is asked about the menstrual cycles and diagnosed whether they are regular or irregular since, major irregularity of periods can show the signs of infertility.

Physical examination includes pelvic exam and tracking the signs of low testosterone levels. Along with it blood tests are done to check the hormonal levels such as LH hormone, FSH hormone which play an important role in fertility.


Other than the above tests some tests are done to assess the uterus and fallopian tubes for any abnormality. Hysteroscopy is done to examine the uterus and fallopian tubes. In this a small tube containing a light source is inserted through the cervix to examine the uterus.

Also Pelvic ultrasound is also done to examine abnormalities such as fibroids and ovarian cysts.