List of Tests for a Couple Who Cannot Conceive

Both partners are examined at the same time. A male factor is present in roughly half of the couples who cannot conceive, so testing only the woman wastes months.

When to see a doctor

• After 12 months of regular intercourse without contraception if the woman is under 35.
• After 6 months if she is 35 or older.
• Right away, without waiting: after 40; with an irregular or absent cycle; with known tubal problems, endometriosis, pelvic inflammatory disease, or surgery on the ovaries, uterus or scrotum; after cancer treatment; when a male factor is suspected.

For the man

1. Doctor’s visit (urologist-andrologist or fertility specialist): medical history and history of attempts to conceive, medicines and supplements, examination including the scrotum (testicular volume, varicocele).
2. Semen analysis according to WHO 2021 criteria (6th edition of the manual). Abstinence of 2–7 days, a laboratory with quality control. Lower reference limits: volume 1.4 mL; concentration 16 million/mL; total count 39 million per ejaculate; progressive motility 30% (total 42%); normal forms 4%; live spermatozoa 54%. A value below the limit does not by itself mean infertility: 5% of men whose partners conceived within a year have results below these limits.
3. Repeat semen analysis if there is an abnormality — after 3 months (the sperm maturation cycle takes about 74 days). If there are no spermatozoa (azoospermia) or very few, the test is repeated sooner and the work-up is extended at once.
4. Hormones — when indicated (abnormal semen analysis, reduced libido, erectile dysfunction, small testicular volume): FSH (follicle-stimulating hormone) and total testosterone, blood drawn in the morning between 8 and 10 a.m. If testosterone is low — repeat testosterone, LH (luteinizing hormone) and prolactin; estradiol and TSH (thyroid-stimulating hormone) at the doctor’s discretion.
5. Genetics — at a concentration of 5 million/mL or lower, or with azoospermia: karyotype and Y-chromosome microdeletions (AZF region). With absent vasa deferentia or obstructive azoospermia — CFTR gene testing (cystic fibrosis), and for his partner as well.
6. Scrotal ultrasound — for findings on examination (varicocele, a mass, a testis that cannot be felt). Transrectal ultrasound — for a low ejaculate volume and suspected obstruction.
7. Low ejaculate volume (less than 1.4 mL) — post-ejaculatory urinalysis to rule out retrograde ejaculation.
8. Not part of the standard initial work-up: sperm DNA fragmentation, antisperm antibodies (MAR test), seminal biochemistry. The doctor orders them separately, for example after recurrent pregnancy loss.

For the woman

1. Visit to a gynaecologist specialising in fertility: cycle, pregnancies and their outcomes, surgery, infections, medicines, examination.
2. Confirmation of ovulation: blood progesterone in the mid-luteal phase — 7 days before the expected period (day 21 of a 28-day cycle). It is checked even with a regular cycle. With an irregular cycle the day of testing and the number of samples are set by the doctor.
3. Hormones on days 2–5 of the cycle: FSH, LH, estradiol. AMH (anti-Müllerian hormone) — on any day of the cycle. AMH and the antral follicle count on ultrasound show ovarian reserve and are needed to plan treatment, but they do not predict the chance of natural conception.
4. TSH — for all women. Prolactin — for cycle disorders, nipple discharge, absent ovulation. With signs of polycystic ovary syndrome (irregular cycle, excess hair growth, acne): total testosterone, SHBG (sex hormone-binding globulin), 17-OH-progesterone; fasting glucose and insulin or a glucose tolerance test — at the doctor’s discretion.
5. Pelvic ultrasound, transvaginal: uterus, endometrium, polyps, fibroids, ovaries, antral follicle count. Best on days 2–5 of the cycle.
6. Tubal patency: hysterosalpingography (X-ray with contrast) or hysterosalpingo-contrast sonography (ultrasound with contrast) if there are no risk factors. With a history of pelvic inflammatory disease or ectopic pregnancy, or with endometriosis, the doctor may offer laparoscopy with a tubal patency test straight away, to assess other causes at the same time. Before any procedure on the uterus — a chlamydia test.
7. Hysteroscopy — only when uterine cavity pathology is suspected on ultrasound (polyp, septum, adhesions).
8. Rubella immunity (IgG antibodies): if absent — vaccination before pregnancy, then postpone conception for 1 month. Cervical cytology (Pap test, HPV test) — if screening is not up to date.

For both partners

• HIV, hepatitis B and C, syphilis — mandatory before assisted reproductive technology (ART) and useful at the start.
• PCR for chlamydia and gonorrhoea.
• Blood group and Rh factor.
• Before ART the clinic adds further tests under the current order of the Ministry of Health of Ukraine (complete blood count, coagulation profile, biochemistry, chest X-ray, smears and more); the full list is given at the appointment.
• Lifestyle is discussed at the appointment: weight (BMI), smoking, alcohol, anabolic steroids and testosterone preparations in the man (they suppress sperm production), overheating, medicines. For the woman — folic acid 400 micrograms a day for at least 3 months before conception.

What to bring to the consultation

Results of tests and ultrasound scans already done, with dates; all semen analyses; the list of medicines and supplements; discharge summaries after surgery and treatment.

This material is educational and does not replace a medical consultation. The scope of testing is decided by the doctor based on the findings at the appointment.

Sources

WHO laboratory manual for the examination and processing of human semen, 6th ed. (2021); AUA/ASRM Guideline: Diagnosis and Treatment of Infertility in Men (2021, amendment 2024); ASRM Committee Opinion: Diagnostic evaluation of the infertile female (2021); NICE NG257 Fertility problems: assessment and treatment (2026); ESHRE Guideline: Unexplained infertility (2023).

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