When to Seek Fertility Testing
Infertility affects approximately 1 in 6 couples worldwide, making it one of the most common reproductive health challenges. The standard medical definition of infertility is the inability to conceive after 12 months of regular, unprotected intercourse for women under 35, or after 6 months for women 35 and older. However, certain factors should prompt earlier evaluation regardless of how long you've been trying: known reproductive conditions (endometriosis, PCOS, fibroids), irregular or absent menstrual periods, history of pelvic inflammatory disease or sexually transmitted infections, previous cancer treatment (chemotherapy or radiation), known male factor issues, and age over 38.
The emotional and financial burden of infertility investigation in Western healthcare systems often delays diagnosis. In the US, a basic fertility workup for a couple can cost $2,000-$8,000 — and this is before any treatment begins. Insurance coverage for fertility testing and treatment varies dramatically by state, with many plans offering limited or no fertility benefits. Long wait times for specialist appointments (often 2-4 months for initial reproductive endocrinology consultation) add frustrating delays to an already emotionally charged process. Medical tourism offers a faster, more affordable pathway to comprehensive fertility diagnosis.
The importance of evaluating both partners simultaneously cannot be overstated. Male factor infertility contributes to approximately 40-50% of all infertility cases, yet many couples focus exclusively on the female partner initially, losing valuable time. A thorough fertility evaluation should assess both partners concurrently, as combined male and female factors contribute to approximately 20% of cases, and in 10-15% of cases, no identifiable cause is found despite thorough investigation (unexplained infertility). Comprehensive couple evaluation abroad is efficient, affordable, and ensures that no diagnostic stone is left unturned.
Female Fertility Testing
Anti-Müllerian Hormone (AMH) is the most important single blood test for assessing ovarian reserve — the quantity of eggs remaining in the ovaries. AMH is produced by small antral follicles in the ovaries and provides a reliable estimate of the remaining egg pool. AMH can be tested on any day of the menstrual cycle (unlike FSH), is not affected by hormonal contraceptives, and is the best predictor of response to ovarian stimulation in IVF. Normal AMH for reproductive-age women is 1.0-3.5 ng/mL; values below 1.0 suggest diminished ovarian reserve, while values above 3.5 may suggest PCOS. AMH declines naturally with age, reflecting the progressive depletion of the egg pool.
FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone) are tested on day 2-3 of the menstrual cycle and provide important information about ovarian function and hormonal balance. Elevated FSH (above 10 IU/L) suggests diminished ovarian reserve. The FSH:LH ratio helps diagnose PCOS (reversed ratio with LH higher than FSH). Estradiol is tested simultaneously — elevated baseline estradiol can mask an elevated FSH. Progesterone is tested on day 21 (or 7 days post-ovulation) to confirm ovulation. Prolactin elevation can cause anovulation. Thyroid function (TSH) is crucial, as both hypothyroidism and hyperthyroidism can impair fertility.
Pelvic ultrasound with antral follicle count (AFC) is performed on day 2-5 of the menstrual cycle and provides direct visualization of the ovaries and uterus. The AFC — the number of small follicles (2-10mm) visible in both ovaries — correlates strongly with ovarian reserve and predicted IVF response. Normal AFC is 10-20 total; fewer than 5-7 suggests diminished reserve. Ultrasound also evaluates uterine anatomy (detecting fibroids, polyps, uterine malformations), endometrial thickness, and ovarian morphology (polycystic ovarian pattern, endometriomas). Follicle tracking ultrasound performed serially through the menstrual cycle monitors follicular growth and timing of ovulation.
Hysterosalpingography (HSG) is a specialized X-ray procedure that evaluates the uterine cavity and fallopian tube patency (openness). During HSG, contrast dye is injected through the cervix into the uterus and fallopian tubes while X-ray images are captured in real time. The test reveals blocked or dilated fallopian tubes (hydrosalpinx), uterine cavity abnormalities (polyps, fibroids, septum, adhesions), and tubal anatomy. HSG is typically performed between days 6-12 of the menstrual cycle (after menstrual bleeding but before ovulation). The procedure takes 15-30 minutes and can cause cramping during dye injection. Interestingly, some studies suggest a slight fertility improvement in the months following HSG, possibly due to flushing of the tubes.
- Blood Tests: AMH, FSH, LH, estradiol (day 2-3), progesterone (day 21), prolactin, TSH, testosterone, DHEA-S
- Pelvic Ultrasound: Antral follicle count, uterine anatomy, ovarian morphology, endometrial assessment
- HSG: Fallopian tube patency and uterine cavity evaluation — essential for treatment planning
- Hysteroscopy: Direct visualization of the uterine cavity — gold standard for detecting intracavitary pathology
- Genetic Testing: Karyotype, CFTR (cystic fibrosis carrier), fragile X screening, preconception carrier panels
- Infectious Screening: HIV, hepatitis B/C, syphilis, rubella immunity, chlamydia/gonorrhea — required before fertility treatment
Male Fertility Testing
Semen analysis is the cornerstone of male fertility evaluation, assessing multiple parameters that reflect testicular function and reproductive tract health. WHO 2021 reference values define normal parameters: volume ≥1.4 mL, concentration ≥16 million/mL, total motility ≥42%, progressive motility ≥30%, morphology ≥4% normal forms (strict Kruger criteria), and vitality ≥54% live sperm. A single abnormal result should be confirmed with a repeat analysis 2-4 weeks later, as semen parameters can fluctuate due to illness, fever, stress, medications, and lifestyle factors. Proper collection (2-5 days abstinence, complete sample, prompt delivery to lab) is essential for accurate results.
Male hormone testing provides insight into the hormonal environment supporting sperm production. Key hormones include FSH (elevated levels suggest primary testicular failure), LH (works with FSH to stimulate testosterone production), testosterone (total and free — essential for spermatogenesis and male reproductive function), estradiol (excess estrogen can impair sperm production), prolactin (elevated levels can suppress reproductive hormones), and thyroid function (thyroid disorders affect fertility in men as well). Physical examination by a urologist or andrologist assesses testicular size and consistency, presence of varicocele (dilated veins in the scrotum, found in 40% of infertile men), and epididymal or vas deferens abnormalities.
Advanced male fertility tests provide deeper insight when standard semen analysis and hormones are inconclusive. Sperm DNA fragmentation testing (SCSA, TUNEL, or SCD methods) measures the integrity of DNA within sperm cells — high fragmentation rates (>30%) are associated with reduced fertility, poor embryo development, and higher miscarriage rates even with apparently normal semen parameters. Reactive oxygen species (ROS) testing measures oxidative stress in the semen, which can damage sperm. Anti-sperm antibody testing detects immune-mediated factors that can impair sperm function. Genetic testing including karyotype (detecting chromosomal abnormalities like Klinefelter syndrome) and Y-chromosome microdeletion analysis can identify genetic causes of severe male factor infertility.
Advanced Fertility Diagnostics
Hysteroscopy involves inserting a thin telescope through the cervix to directly visualize the uterine cavity. It is the gold standard for evaluating intrauterine pathology and can be both diagnostic and therapeutic — polyps, fibroids, adhesions, and septa identified during the procedure can often be treated simultaneously. Office hysteroscopy (without anesthesia) takes 5-10 minutes and is performed as an outpatient procedure. Operative hysteroscopy (under sedation) allows more complex interventions. Hysteroscopy is particularly important before IVF, as uterine abnormalities can reduce implantation rates.
Laparoscopy is a minimally invasive surgical procedure that provides direct visualization of the pelvic organs — uterus, fallopian tubes, ovaries, and peritoneal surfaces. While not a first-line fertility investigation, laparoscopy is valuable for diagnosing and treating endometriosis (which may be missed by ultrasound and HSG), evaluating tubal patency when HSG results are equivocal, and investigating unexplained infertility when other tests are normal but conception has not occurred. Diagnostic laparoscopy reveals endometriosis in approximately 30-50% of women with unexplained infertility — a finding that can fundamentally change the treatment approach.
Cost Comparison by Country
Fertility Diagnostics Cost Comparison 2025
| Country | Basic Female Workup | Basic Male Workup | Comprehensive Couple Workup |
|---|---|---|---|
| USA | $1,000 - $3,000 | $500 - $1,500 | $2,000 - $8,000 |
| UK | $600 - $2,000 | $300 - $1,000 | $1,500 - $5,000 |
| Turkey | $200 - $600 | $100 - $300 | $300 - $1,200 |
| India | $100 - $400 | $50 - $200 | $200 - $800 |
| Thailand | $250 - $700 | $100 - $400 | $400 - $1,500 |
| Czech Republic | $200 - $500 | $100 - $300 | $300 - $1,000 |
| Spain | $300 - $800 | $200 - $500 | $500 - $1,800 |
Basic female: AMH, FSH, LH, estradiol, thyroid, prolactin, pelvic ultrasound. Basic male: semen analysis, hormone panel. Comprehensive: adds HSG, hysteroscopy, DNA fragmentation, genetic testing, advanced hormone panels.
Fertility diagnostics represent one of the areas where medical tourism offers the most significant financial relief. In the US, a complete fertility evaluation for a couple — including female hormone panel, AMH, ultrasound with AFC, HSG, semen analysis, male hormones, and specialist consultations — easily costs $2,000-$8,000 before any treatment begins. In Turkey, the same comprehensive workup costs $300-$1,200 at JCI-accredited reproductive medicine centers with internationally trained fertility specialists. India offers even lower pricing at $200-$800. The savings become even more dramatic when advanced diagnostics like hysteroscopy, laparoscopy, or genetic testing are needed.
Best Hospitals for Fertility Diagnostics Abroad
Memorial Sisli Hospital in Istanbul has a comprehensive Reproductive Medicine and IVF Center with advanced diagnostic capabilities for both male and female infertility. Their laboratory is equipped for advanced semen analysis including morphology assessment, DNA fragmentation testing, and sperm function assays. The center performs HSG, hysteroscopy, and follicle tracking ultrasound with experienced reproductive endocrinologists. Integration between diagnostics and treatment means that if fertility treatment is indicated, the transition from diagnosis to treatment plan is seamless — with IVF, ICSI, PGT, and other assisted reproductive technologies available at the same center.
Acıbadem Maslak Hospital operates one of Turkey's leading reproductive medicine centers with a strong focus on diagnostic accuracy and personalized treatment planning. Their fertility workup protocol is comprehensive and efficient, with most testing completed within 2-3 days for international patients. The center's andrology laboratory meets WHO standards for semen analysis, and their genetics department offers preconception genetic screening, karyotyping, and Y-chromosome microdeletion analysis. The hospital's dedicated international patient department coordinates all aspects of the fertility evaluation experience.
Struggling to conceive? Get comprehensive fertility diagnostics at world-class reproductive medicine centers.
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Infertility is a medical condition that deserves thorough investigation. In at least 85% of cases, the cause of infertility can be identified through proper evaluation, and in most cases, effective treatment is available. The key is comprehensive, simultaneous evaluation of both partners without unnecessary delay.
American Society for Reproductive Medicine, Infertility Evaluation Guidelines
Frequently Asked Questions
When should we start fertility testing?
Seek testing after 12 months of unprotected intercourse if the woman is under 35, or after 6 months if over 35. Women over 38 or those with known risk factors (irregular periods, endometriosis, PCOS, previous pelvic surgery) should seek evaluation even earlier. Male testing (semen analysis) should be done simultaneously — don't wait to investigate both partners.
Is fertility testing painful?
Most fertility tests are painless. Blood draws and ultrasound are comfortable. HSG can cause cramping during dye injection (taking ibuprofen beforehand helps). Hysteroscopy may cause mild cramping. Semen analysis requires only providing a sample. Your specialist will discuss any procedure-specific comfort measures before each test.
How long does a complete fertility workup take?
A basic fertility workup can be completed in 1-2 visits spread across one menstrual cycle (day 2-3 blood tests and ultrasound, day 21 progesterone, HSG on day 6-12). International patients can often complete testing in 3-5 days with efficient scheduling. Advanced testing (hysteroscopy, laparoscopy) may require an additional visit.
Can we start IVF treatment during the same trip?
Diagnostics and IVF treatment cannot usually be combined in a single trip because IVF requires a specific treatment protocol timed to your menstrual cycle. However, many patients complete diagnostics on one trip and return for treatment 1-2 months later. Some clinics offer remote monitoring protocols where part of the preparation is done at home.
What if no cause of infertility is found?
Unexplained infertility is diagnosed in 10-15% of couples after thorough evaluation. This doesn't mean there's no cause — it means current testing cannot identify it. Treatment options include timed intercourse with ovulation induction, intrauterine insemination (IUI), and IVF. Many couples with unexplained infertility achieve successful pregnancies with assisted reproductive technologies.
Does age affect male fertility?
Yes, though less dramatically than female fertility. Male fertility begins declining after age 40, with decreasing sperm quality, increased DNA fragmentation, and slightly higher rates of genetic abnormalities. However, men can remain fertile much later in life than women. Both partners' age should be considered in fertility evaluation and treatment planning.