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Investigations of Infertile Couples

February 24, 2024

When you start your journey of parenthood, there can be some challenges for some couples due to infertility. So, healthcare providers have to investigate infertility causes and the factors that impede natural conception. This investigation involves examining various aspects of health, including reproductive health, genetics, hormonal imbalances, lifestyle factors and more. By doing so, you get to know the root cause of infertility and then choose treatment plans to enhance the chances of conception.

Book an Appointment with Dr. Pooja Uniyal for all your Fertility concerns.

Risk Factors for Infertility

Male infertility is defined as the lack of ejaculatory functions or inadequate sexual functions. Whereas female infertility is defined as a woman’s inability to conceive or carry the pregnancy until childbirth. Various risk factors contribute to infertility. Here are some risk factors:

For Both Genders

  • Family history of infertility
  • Using steroids
  • Obesity
  • Environmental or occupational factors
  • The harm caused by a physician while treating a medical condition
  • Lifestyle factors
  • Infection
  • Endocrine diseases
  • Cystic Fibrosis

For Men

  • Varicocele (a condition of swelling of veins that drain the testicle)
  • Smoking
  • Sexually Transmitted Infections
  • Testicular overheating
  • Cryptorchidism (a condition where the testicles do not descend to the scrotum)
  • Intrinsic testicular damage
  • Testicular torsion
  • Testicular damage
  • Puberty disorders
  • Ageing

For Women

  • Age over 35 years
  • Reduced ovarian reserve
  • Ovulation disorders
  • Menstrual disorders
  • Endometriosis
  • Infectious diseases
  • Hormonal dysfunctions
  • Pelvic inflammation
  • Tubal obstructions
  • Irregular menstruation

Infertility Tests for Men

Male fertility is dependent on the testicles producing healthy sperm. Certain tests can be done for the reasons behind male infertility. Here are the tests that are done.

  • Physical examination: A check is done on the genitals
  • Semen Analysis: Your healthcare provider will take a sample of your semen, and then it is sent to the lab to check if it contains sperm and is healthy.
  • Hormone testing: A blood test is done to determine the level of many male hormones, including testosterone.
  • Genetic Testing: This is done to check if there are genetic defects that cause infertility. In rare cases, the quality of semen is checked to know if there are DNA problems that damage sperm.
  • Testicular Biopsy: It is a rare test done to determine if there are any blockages in the reproductive tract that prevent the sperm from leaving the body. In this procedure, a small quantity of testicle tissue is removed and sent to a lab for testing. It is also collected for IVF (in-vitro fertilization), which is an assisted reproductive technique.
  • Imaging: In a few cases, your doctor recommends imaging, which can be an ultrasound to determine defects in the scrotum, in the glands that make semen or in the tube that transports sperm to the testicles. A brain MRI may be checked for pituitary gland tumor's, which cause the gland to produce too much prolactin, which leads to less semen production.

Infertility Tests for Women

A woman’s fertility depends on the release of healthy eggs by the ovaries. The reproductive tract should allow the eggs to pass to the fallopian tube and fuse with the sperm. Then, the fertilised egg should move to the uterus and be fixed to the uterine lining. Female infertility tests are done to determine the root cause for problems in any of the above steps. Women’s infertility investigation involves:

  • Physical Examination: A physical exam is done to check the vitals, along with a pelvic exam.
  • Ovulation test: It is one of the basic investigations of infertility. Blood is drawn by the healthcare provider to check the hormone levels and determine if you are ovulating.
  • Thyroid function: A blood test to check if the infertility is due to a thyroid gland problem. If the gland is producing too little or too much thyroid hormone, then it can be the cause of infertility.
  • Hysterosalpingography: This is done to check the condition of the fallopian tube and the uterus. It also tests for any fallopian tube blockages or other issues. This is an x-ray with a special dye injected into the uterus.
  • Ovarian reserve test: This is a method to determine the quantity of eggs produced during ovulation and is done along with hormone testing very early in your periods.
  • Imaging: Ultrasound of the pelvis to check for diseases in the ovaries or uterus. A sonogram is done to check the inside of the uterus using a saline infusion and is called Son hysterogram.
  • Other hormone tests: These are done to determine the hormone levels that control ovulation. Pituitary hormones are also checked as they help in having a baby.

Rare Tests

  • Hysteroscopy: This is a test recommended by your doctor based on your symptoms. It is a procedure where the inside of the uterus is checked using a light and thin tube called a hysteroscope. This can determine various diseases and uterine conditions and is a non-invasive procedure. This is recommended when there is abnormal bleeding, repeated miscarriages or abnormal findings in imaging tests.
  • Laparoscopy: This is a procedure where a small cut is made below the navel. A thin device with a camera is placed using that cut to check the uterus, ovaries and fallopian tubes. This procedure may determine problems with fallopian tubes, scarring, blocking and endometriosis. It can also treat many specific conditions by removing endometriosis tissues and fibroids.

Also Read : Laparoscopic Surgery: All You Need To Know

Infertility Evaluation of Older Couples

Many women delay childbearing for various reasons, and hence, infertility among women in their late 30s or early 40s is common. The infertility evaluation is more comprehensive as there are many factors that hinder their conception ability. Fertility naturally declines in both women and men, and various factors like lifestyle and medical issues add to infertility. A detailed medical history to know chronic illnesses or preexisting conditions is taken along with some or all of the above tests which are recommended for older couples. It is best that they consult a fertility specialist to discuss IVF or other assisted reproductive techniques.

It is essential to note that not everyone needs all of the above tests as part of investigations of infertile couples if the cause of infertility is found with basic tests. Your doctor is the best judge to decide which tests to have and when.


1. What are the basic investigations of infertility?

A pelvic examination, blood tests to determine ovarian reserve and hormone levels and a sonogram to check for structural issues are basic investigations for infertility.

2. How do you investigate a case of infertility?

Less invasive exams are done, which include a physical examination and questionnaires to find lifestyle factors, BMI and weight. Your medical history and family history will also be investigated.

3. What are the lab tests for infertility?

Hormone testing, semen analysis, imaging, testicular biopsy, ultrasound and blood tests are some of the lab tests for infertility.

4. How do you investigate infertility?

For women, the doctor will start with a pelvic exam. Ultrasound is done to check the uterus and ovaries. A blood test is taken to determine hormone levels. You may have to track ovulation patterns using a home ovulation kit. For men, it starts with a physical examination followed by semen analysis and a blood test to check hormone levels.

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