Infertility diagnosis uses data-driven, dual-partner evaluation to identify underlying causes and create a personalized roadmap for effective treatment.
Send us all your questions or requests, and our expert team will assist you.
How Is Infertility Diagnosed and Evaluated?
The journey to resolving infertility begins with a shift from uncertainty to data. Diagnosis is the process of peeling back the layers of reproductive health to identify exactly where the biological chain is breaking. For many couples, this phase is a relief; it provides a name for their struggles and a concrete starting point for medical action. A comprehensive evaluation doesn’t just look for “problems”; it creates a roadmap of your unique fertility profile.
In modern reproductive medicine, the diagnostic process is a dual investigation. Because fertility is a shared journey, both partners are evaluated simultaneously. This efficiency prevents the loss of valuable time and ensures that the treatment plan accounts for all contributing factors. From high-resolution imaging to genetic analysis, the tools used today are more precise than ever before.
The Comprehensive Clinical Interview
Every diagnostic path starts with a detailed history. A specialist will look at your menstrual history, past illnesses, surgeries, and lifestyle habits. For women, the focus is on the regularity of cycles and any history of pelvic pain. For men, the interview explores the history of testicular injury, childhood illnesses like mumps, or exposure to environmental toxins.
This conversation often reveals subtle clues, such as a history of heavy periods or a previous abdominal surgery, that guide the selection of more specific tests.
Ovarian Reserve Testing
One of the most critical questions for a woman is the status of her “egg timer.” Ovarian reserve testing evaluates the quantity and quality of a woman’s remaining eggs.
This is primarily done through blood tests measuring Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH). Additionally, a transvaginal ultrasound is used to perform an Antral Follicle Count (AFC), which visually assesses the number of “sleeping” follicles in the ovaries. These tests help determine the urgency of treatment and the likely response to fertility medications.
Semen Analysis: The Male Cornerstone
For men, the semen analysis is the most vital diagnostic tool. It is a non-invasive test that provides a wealth of information about sperm concentration (count), motility (how well they swim), and morphology (their shape). Even if a man has fathered a child in the past, sperm quality can change due to age, illness, or lifestyle factors. If the initial analysis shows irregularities, a repeat test is often performed to ensure consistency before a diagnosis of male factor infertility is made.
Tracking Ovulation Function
Confirming that ovulation is actually occurring is a baseline step. While many women use home-based kits to track luteinizing hormone (LH) surges, clinical diagnosis involves more precise measures.
Blood tests can measure progesterone levels in the second half of the cycle to confirm that an egg was released. If ovulation is irregular or absent, further testing focuses on the pituitary gland and thyroid, as these organs act as the “control center” for the ovaries.
Hysterosalpingography (HSG)
The HSG is a specialized X-ray used to view the internal shape of the uterus and ensure that the fallopian tubes are open. A contrast dye is gently injected through the cervix, and X-ray images track its path. If the dye flows through the tubes and spills into the pelvic cavity, the tubes are clear. If the dye is blocked, it indicates tubal factor infertility, which prevents the egg and sperm from meeting.
This test also reveals uterine abnormalities like scarring or a septum that could interfere with implantation.
Transvaginal Pelvic Ultrasound
Ultrasound technology serves as the “eyes” of the fertility specialist. A transvaginal ultrasound provides a high-resolution view of the uterine anatomy and the ovaries. It is used to detect uterine fibroids, endometrial polyps, and ovarian cysts (such as endometriomas).
Ultrasound is also the primary tool for diagnosing Polycystic Ovary Syndrome (PCOS) by identifying the characteristic “string of pearls” appearance of small follicles on the ovaries.
Sonohysterography (Saline Infusion Ultrasound)
When a standard ultrasound or HSG isn’t detailed enough to see the uterine lining, a saline infusion sonogram is performed. Sterile saline is used to inflate the uterine cavity, providing a clear contrast that allows the doctor to see small growths or irregularities on the internal walls.
This is particularly important for identifying submucosal fibroids or scar tissue from previous procedures (Asherman’s Syndrome) that could prevent a successful pregnancy.
Diagnostic Laparoscopy and Hysteroscopy
In some cases, the “gold standard” for diagnosis is direct visualization. Laparoscopy involves a tiny incision in the navel to insert a camera into the abdomen, allowing the doctor to see endometriosis or adhesions that don’t show up on X-rays or ultrasounds. Hysteroscopy involves a camera inserted through the cervix to view the inside of the uterus.
These procedures are often both diagnostic and therapeutic, as the doctor can often fix the problem (like removing a polyp) while they are looking at it.
Genetic and Chromosomal Screening
For couples experiencing recurrent pregnancy loss or failed IVF cycles, genetic testing may be required. Karyotyping is a blood test for both partners that looks for chromosomal rearrangements. Additionally, advanced preimplantation genetic testing (PGT) can be performed on embryos during an IVF cycle to ensure they have the correct number of chromosomes.
This diagnostic layer is essential for avoiding genetic conditions that lead to miscarriage.
Evaluating the Endometrial Receptivity
Even with a healthy embryo and open tubes, the “soil” (the uterine lining) must be ready for the “seed.” The Endometrial Receptivity Array (ERA) is a biopsy-based test that determines the exact window of time when the uterus is most receptive to an embryo.
This is often used for couples who have had multiple failed embryo transfers, ensuring that the timing of the next attempt is mathematically optimized for success.
Expert Care at Liv Hospital
At Liv Hospital, we believe that an accurate diagnosis is the cornerstone of a successful pregnancy. Our Advanced Diagnostic Suite features the latest 4D ultrasound technology and world-class laboratory facilities for endocrine and genetic testing. Our specialists don’t just hand you a report; they sit down with you to explain the data and what it means for your future.
With a commitment to “high-tech, high-touch” medicine, Liv Hospital ensures that your evaluation is as comfortable as it is comprehensive, providing the clarity you need to move forward with confidence
Send us all your questions or requests, and our expert team will assist you.
Most diagnostic tests are tied to the menstrual cycle, so a full evaluation typically takes about one full cycle (4 weeks) to complete.
Most women experience some cramping when the dye is injected, similar to a heavy period cramp, but the discomfort usually lasts only a few minutes.
It is not recommended. Diagnostic tests ensure you aren’t undergoing expensive treatments for a problem that could be solved with a simpler intervention.
This is called “unexplained infertility.” It doesn’t mean there isn’t a cause; it just means it is occurring at a level (like egg-sperm interaction) that current tests cannot see.
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