The initial workup: what tests to expect
AMH, FSH, HSG, semen analysis — what each one tells you and what it doesn't.
What a complete workup includes
A standard infertility workup looks at three things: ovulation and egg supply, the uterus and fallopian tubes, and sperm. Most clinics complete the entire workup in 4–8 weeks.
AMH and AFC (egg supply)
AMH is a single blood draw, can be done on any cycle day, and is unaffected by hormonal contraception in most labs. AFC is a transvaginal ultrasound counting small follicles, typically done on cycle days 2–4. Together they predict how your ovaries will respond to IVF medications. Neither predicts your chance of natural conception.
FSH and estradiol (cycle day 3)
Drawn on cycle day 2, 3, or 4. High FSH suggests the ovaries are working harder to recruit eggs — a sign of diminished reserve. Estradiol is interpreted alongside FSH because elevated estradiol can falsely suppress FSH.
HSG (hysterosalpingogram)
An X-ray that injects dye through the cervix to confirm fallopian tubes are open and the uterine cavity is normal. Done between cycle day 6 and 12. Most people describe brief, sharp cramping; ibuprofen 30–60 minutes before helps.
Semen analysis
Per WHO 2021 reference values: volume ≥1.4 mL, concentration ≥16 million/mL, total motility ≥42%, normal morphology ≥4%. One abnormal result should be repeated 2–3 months later because sperm production cycles take ~74 days.
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- American Society for Reproductive Medicine (ASRM)
- American College of Obstetricians and Gynecologists (ACOG)
- RESOLVE: The National Infertility Association
Cited figures (cycle counts, dollar ranges, mandate lists) reflect publicly available data as of early 2026. Always confirm specific numbers against the linked sources before relying on them — pricing, protocols, and laws change.
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