Fertility · 6 min read

What a fertility evaluation actually involves

Couples often arrive having already decided they need IVF. Usually they have been trying for a long time, they have had a lot of advice from a lot of people, and they want to get on with it. That impulse is completely understandable and it is also the thing most likely to cost them money they did not need to spend.

IVF is the answer to some fertility problems and not to others. Starting it without knowing which problem you have is expensive guesswork. An evaluation takes about three weeks, and in a fair number of couples it finds something simpler to treat.

The three questions

Every fertility evaluation is trying to answer three things. Is an egg being released each month? Is there a clear path for it to travel and for sperm to reach it? And is the sperm able to fertilise it when they meet?

Almost every test in the work-up maps onto one of those three. Knowing which question a test is answering makes the whole process much less bewildering.

Question one: is an egg being released?

This is answered with blood tests timed to particular days of your cycle, and with a scan of the ovaries. The timing is why an evaluation cannot be compressed into a single week — some of these results only mean something on day two or three, and some on day twenty-one.

Irregular or absent periods are the obvious clue, but ovulation can be a problem even when periods seem regular, which is why we test rather than assume. Thyroid function is checked at the same time, because thyroid problems are common, easily missed, and easily treated.

Question two: is the path clear?

The fallopian tubes cannot be seen on an ordinary scan. Checking them needs a specific test, usually an HSG, in which dye is passed through the uterus and watched on X-ray to see whether it spills out of the ends of the tubes.

Not everyone needs this test. If your history and other results make tubal disease unlikely, we may not do it. If you have had pelvic infection, previous surgery, or endometriosis, it matters a great deal.

Question three: the sperm

A semen analysis looks at count, movement and shape. It is one of the simplest, cheapest and most informative tests in the whole work-up, and it is the one most often skipped.

Male factors are involved in roughly half of all couples with difficulty conceiving. A work-up that tests only the woman is not a work-up. If your husband is reluctant — and many are — it is worth saying that the test is a single sample, done on site, with a result in a day.

One abnormal result does not settle anything. Semen quality varies a great deal between samples, and a poor first result is repeated after a few weeks before anything is concluded from it.

What happens when everything comes back normal

In roughly one couple in five, the evaluation finds nothing. This is called unexplained infertility and it is a real finding rather than a failure of the tests — it tells us there is no structural or hormonal obstacle we can point at.

It is also, understandably, one of the most frustrating results to be given. It changes what we would suggest next, and we will talk through what the options are when nothing specific is wrong.

Then you sit down with the results

The last appointment is the one that matters. Everything is put together and explained, the options are set out with what each involves and costs, and it is written down so you can read it again at home and discuss it without a doctor in the room.

Sometimes the honest recommendation is to keep trying for a few more months. That is a legitimate medical answer and you should be suspicious of anywhere that never gives it.

Written and reviewed by Dr. Hardik Vansjaliya, M.S. (Obs & Gynaec), D.M.A.S., F.M.A.S., Fellow in IVF, M.B.A. (Healthcare), Gujarat Medical Council Reg. G/24936. Published 2026-08-14. Last checked 2026-08-14.

This article is general information, not medical advice about your own situation. If something here applies to you, come and talk to us.