You've decided to get tested. Maybe you've been trying for a year with no success. Maybe you're 35 and want to know where you stand before you start. Maybe your gynecologist mentioned that your periods have been irregular and suggested checking your fertility before you begin trying.

Whatever the reason — this is the right move.

The problem is that fertility testing can feel like a maze. Different doctors order different tests. Costs vary wildly. Results come back with numbers that mean nothing without context. And the sequence matters — there's a logical order to do this in that most doctors don't explain.

This guide walks you through all of it.

Start Here: Who Should Get Tested

If you've been trying for 12 months without success (or 6 months if you're 35 or older), a fertility workup is warranted. Full stop.

But you don't have to wait. You can get tested proactively if:

  • You have irregular periods (cycles shorter than 21 days or longer than 35 days)
  • You've had previous pelvic surgeries, endometriosis, or known PCOS
  • Your partner has had a vasectomy reversal or any prior scrotal surgery
  • You're over 35 and planning to start trying soon
  • You've had 2 or more miscarriages

Getting tested early doesn't mean rushing into treatment. It means knowing what you're working with.

The Basic Fertility Workup: What to Get First

Start with these. They're affordable, widely available, and will tell you most of what you need to know.

For Women

AMH (Anti-Müllerian Hormone)

This is probably the most useful single test for assessing ovarian reserve — roughly, how many eggs you have remaining. AMH is produced by small follicles in your ovaries. Higher levels suggest a larger pool of eggs; lower levels suggest diminished ovarian reserve.

What it tells you: Your egg quantity (not egg quality). Whether your reserve is typical for your age, or above/below average.

What it doesn't tell you: Whether your eggs are chromosomally normal, whether you'll conceive naturally, or whether IVF will work.

Normal range varies by lab, but roughly: AMH above 2.0 ng/mL is considered normal for reproductive-age women. Below 1.0 is low; below 0.5 is very low. Context matters — these numbers mean different things at 28 vs 38.

Cost in India: ₹800–2,000 depending on lab.

Day 2/3 Hormone Panel: FSH, LH, Estradiol (E2)

These tests are done on Day 2 or 3 of your menstrual cycle (Day 1 = first day of full flow).

  • FSH (Follicle Stimulating Hormone): High FSH on Day 3 (above 10–12 IU/L) suggests your pituitary gland is working harder to stimulate your ovaries — a sign of reduced ovarian reserve.
  • LH (Luteinising Hormone): Elevated LH relative to FSH (LH:FSH ratio > 2:1) can indicate PCOS.
  • Estradiol: Very high Day 3 estradiol can suppress FSH, making FSH levels look falsely normal.

Cost: ₹600–1,500 for the panel.

TSH (Thyroid Stimulating Hormone)

Thyroid dysfunction is common in Indian women — particularly hypothyroidism — and it directly affects fertility and pregnancy outcomes. A simple, cheap test.

Cost: ₹300–600.

Prolactin

Elevated prolactin can interfere with ovulation. Often elevated in women with irregular periods or in those who are breastfeeding. If elevated, it's almost always treatable (usually with cabergoline).

Cost: ₹400–700.

Pelvic Ultrasound (Antral Follicle Count)

A transvaginal ultrasound done early in your cycle (Day 2–5) counts the number of small antral follicles visible in each ovary. This is the antral follicle count (AFC) — another marker of ovarian reserve that complements AMH.

AFC above 15–20 (combined across both ovaries) suggests good reserve. AFC below 7–8 suggests diminished reserve.

The same ultrasound will also check for:

  • Ovarian cysts
  • Signs of PCOS (polycystic ovarian morphology — multiple small follicles arranged peripherally)
  • Uterine fibroids or polyps
  • Endometrial thickness and appearance

Cost: ₹800–1,800 at most clinics. Free or heavily subsidised at government hospitals.

For Men

Semen Analysis

This is the single most important male fertility test and should be done in parallel with the female workup. There's no reason to spend months investigating the female partner if a significant male factor hasn't been ruled out.

What a complete semen analysis measures:

  • Volume: Normal ≥ 1.5 mL
  • Sperm concentration: Normal ≥ 16 million/mL
  • Total sperm count: Normal ≥ 39 million per ejaculate
  • Motility: Normal ≥ 42% total motility, ≥ 30% progressive motility
  • Morphology (Kruger strict criteria): Normal ≥ 4% normal forms
  • DNA fragmentation index (DFI): Often not part of basic analysis, but important if basic parameters are borderline or if there have been recurrent miscarriages (see below)

For accurate results: 2–5 days of abstinence before the sample. Sample collected at the lab or transported there within 30–60 minutes if collected at home.

Cost: ₹500–1,200 for basic semen analysis. ₹2,500–5,000 if DNA fragmentation is included.

One abnormal semen analysis should always be repeated after 2–4 weeks before drawing conclusions. Many factors (fever, illness, alcohol, stress) can temporarily affect results.

Second-Line Tests: Based on First Results

These aren't for everyone. You order them based on what the first-line tests show.

HSG (Hysterosalpingography)

An HSG checks whether your fallopian tubes are open and whether your uterine cavity is normal. Dye is injected through the cervix and X-rays are taken to see if it flows through the tubes.

When you need it: If you've been trying for 6–12 months without success, or before starting IUI (blocked tubes make IUI futile).

What it shows: Tubal patency (open vs. blocked), hydrosalpinx (fluid-filled tube), uterine polyps or submucosal fibroids, uterine adhesions.

What it doesn't show: Endometriosis, small fibroids outside the cavity, ovarian issues.

Is it painful? HSG can be uncomfortable — ranging from mild cramping to significant pain, depending on the patient and the technique. Taking ibuprofen 30–60 minutes before helps. It takes about 20 minutes total. Most women are fine to drive home.

Cost: ₹2,000–6,000 depending on city and clinic. Often slightly cheaper at government hospitals or radiology centres.

Sonohysterogram (SIS / Saline Infusion Sonography)

Similar to HSG but uses saline and ultrasound instead of dye and X-ray. Better at detecting intrauterine abnormalities (polyps, fibroids inside the cavity). More comfortable than HSG. Doesn't assess tube patency as well.

Cost: ₹1,500–4,000.

Laparoscopy + Hysteroscopy

Surgical tests — done only when imaging suggests or when symptoms indicate conditions like endometriosis, pelvic adhesions, or uterine abnormalities that can't be confirmed non-invasively. Not a routine first-line test.

Sperm DNA Fragmentation

Measures the percentage of sperm with damaged DNA. Normal: DFI below 15%. High DFI (above 25%) is associated with reduced fertilisation rates, poorer embryo quality, and increased miscarriage risk.

When to order it: Recurrent miscarriage, repeated IVF failure with poor embryo development, severe male factor infertility, varicocele.

Cost: ₹2,500–5,000.

Genetic Tests

Karyotyping (chromosomal analysis) of both partners is sometimes recommended before IVF — especially with recurrent miscarriage, very poor semen parameters, or a family history of genetic conditions.

Specialised tests like carrier screening (for Thalassemia, SMA, Cystic Fibrosis) are increasingly common, particularly for couples considering IVF with PGT-A (preimplantation genetic testing).

Cost: ₹3,000–8,000 for karyotype. Carrier screening panels vary significantly.

How to Read Your Results: Context Matters

A few things to understand before you spiral over a number:

AMH doesn't determine your fate. Low AMH means fewer eggs to work with. It doesn't mean conception is impossible. Many women with AMH of 0.4–0.8 ng/mL have had successful IVF outcomes — it typically means the doctor stimulates more carefully and you may get fewer eggs per retrieval. What matters more is egg quality, which AMH doesn't measure.

One bad semen analysis isn't a diagnosis. Sperm parameters fluctuate significantly. Illness, fever, stress, alcohol — all of these affect results temporarily. A low sperm count test should always be repeated before any clinical decision is made.

FSH ranges vary by lab. Your Day 3 FSH result should be interpreted alongside AMH and AFC, not in isolation. High FSH with normal AMH and AFC is less concerning than high FSH with low AMH and low AFC.

Irregular periods and PCOS don't mean infertility. PCOS is actually the most common cause of anovulatory infertility — meaning the primary problem is irregular or absent ovulation, which is very often treatable. Many women with PCOS conceive without IVF, with oral medication alone.

The Right Order to Get Tested

Don't throw money at every test at once. Do this:

  1. 1Week 1: Both partners — male semen analysis, female AMH + Day 2/3 hormone panel (FSH, LH, E2) + TSH + prolactin. Pelvic ultrasound (ideally Day 2–5 of cycle).
  2. 2Review results with a doctor. Based on those results, the next steps become clearer.
  3. 3If results suggest a tubal concern, planning IUI, or unexplained infertility: HSG.
  4. 4If semen analysis shows abnormalities: Repeat after 3–4 weeks. If still abnormal, add sperm DNA fragmentation.
  5. 5If moving toward IVF: AMH, AFC, and Day 3 hormones are the key inputs for ovarian stimulation planning. Add HSG if not done. Karyotype if there's a genetic concern.

What Tests Cost in India

| Test | Typical Range (India) |

|---|---|

| AMH | ₹800–2,000 |

| Day 3 FSH + LH + E2 | ₹600–1,500 |

| TSH | ₹300–600 |

| Prolactin | ₹400–700 |

| Pelvic ultrasound (AFC) | ₹800–1,800 |

| Semen analysis (basic) | ₹500–1,200 |

| Sperm DNA fragmentation | ₹2,500–5,000 |

| HSG | ₹2,000–6,000 |

| Sonohysterogram | ₹1,500–4,000 |

| Karyotype (both partners) | ₹3,000–8,000 |

Complete first-line workup (both partners, no HSG yet): approximately ₹5,000–12,000 depending on city and lab.

Many diagnostic labs (Dr. Lal PathLabs, SRL, Metropolis, Thyrocare) offer AMH and hormone panels at standardised prices. You don't need to get these done at a fertility clinic — you can order them from any certified pathology lab. Clinic labs often charge more for the same test.

When to See a Fertility Specialist

Your gynaecologist can order most of these tests. But you should see a reproductive endocrinologist (fertility specialist) if:

  • You've been trying for 12 months (or 6 months if 35+)
  • Any first-line test shows abnormal results
  • You have a history of PCOS, endometriosis, or recurrent miscarriage
  • Semen analysis is abnormal
  • You're planning to freeze your eggs

For guidance on finding the right specialist, see our guide to choosing a fertility clinic in India.

FAQ

Can I order these tests without a doctor's referral?

Yes. Most diagnostic labs in India do not require a doctor's referral for blood tests like AMH, FSH, LH, TSH, and prolactin. You can walk in and order them yourself. For HSG, you'll need a doctor's referral and it's done at a radiology or fertility clinic, not a standard pathology lab.

What is a "normal" AMH for my age?

Rough benchmarks:

  • Age 20–30: 3.0–5.0 ng/mL typical
  • Age 30–35: 2.0–3.5 ng/mL typical
  • Age 35–38: 1.0–2.5 ng/mL typical
  • Age 38–42: 0.5–1.5 ng/mL typical
  • Age 42+: below 1.0 ng/mL common

These are rough guidelines. Labs use different assays with different reference ranges — always ask your doctor to interpret your result in context, not just against a chart.

My semen analysis shows low motility. What does that mean?

Asthenozoospermia (low motility) is common and often treatable. Lifestyle factors (heat, smoking, excessive alcohol) are common contributors. Your doctor may recommend a repeat test, lifestyle changes, and antioxidant supplementation as a first step. Severe motility issues may indicate a need for ICSI (intracytoplasmic sperm injection) if IVF is indicated. See our guide to male infertility.

My tubes are blocked on one side. Can I still conceive naturally?

Possibly, yes. Ovulation alternates sides in most cycles, and a blocked tube on one side doesn't prevent conception — you'd just be relying on the open side. If both tubes are blocked, natural conception is unlikely and IVF becomes the appropriate treatment path.

We've been trying for 8 months and everything looks normal. What's next?

Unexplained infertility — where all standard tests are normal — is more common than most people expect. It accounts for about 10–15% of infertility cases. Management typically begins with stimulated IUI (2–3 cycles) and then IVF if IUI is unsuccessful. "Normal tests" don't guarantee natural conception; they just rule out the most common identifiable causes.

Once you have your test results, the next question is usually which treatment to start with. Our IUI vs IVF guide helps you understand what your test results mean for treatment planning.