Fertility Tests for Women: The Complete India Workup Guide

• When to start depends on age: a workup is advised after 12 months of trying if you are under 35, after 6 months at 35 to 37, and sooner if you are 38 or older or have risk factors.
• A complete female workup has four pillars: hormone tests, an ovulation check, tubal patency (usually HSG), and a uterine cavity scan. Hormones alone are not enough.
• Your partner must be tested too. A semen analysis is cheap, quick, and finds the cause in 30 to 50 percent of couples, so it should be done early.
• A basic couple workup in India typically costs Rs 12,000 to Rs 36,000 in private centres, far less at government and teaching hospitals.
• Results are read together, not in isolation. Many couples have more than one factor, and most factors are treatable with lifestyle changes, medication, surgery, or assisted reproduction.

• Under 35: after about 12 months of trying
• Age 35 to 37: after about 6 months
• Age 38 to 39: after about 3 to 6 months
• Age 40 and above: consider testing straight away or after a short try

Blood tests build a picture of your ovarian reserve, whether you are ovulating, and whether a hormonal disorder is interfering. Some are timed to specific cycle days; others can be drawn any day. Costs below are typical private-lab ranges and vary by city and lab.

AMH (anti-Mullerian hormone) estimates your ovarian reserve, meaning roughly how many eggs remain. It can be drawn on any cycle day, costs about Rs 1,500 to Rs 3,500, and is useful for fertility planning, IVF dosing, and PCOS assessment. A low AMH does not mean you cannot conceive naturally; it speaks to quantity, not the quality of any single egg. For the full picture see our dedicated AMH test guide.

Day 2 to 3 FSH, LH, and estradiol are drawn together early in the cycle. FSH is the pituitary's signal to the ovaries; a high level suggests the ovaries need more prompting and reserve may be reduced. A normal day 2 to 3 FSH is roughly 4 to 12 mIU/mL, with values above 10 to 15 suggesting reduced reserve and above 40 with low estradiol pointing toward menopause or premature ovarian insufficiency. FSH must be read alongside estradiol from the same sample, because a high estradiol can mask a high FSH. The LH to FSH ratio can support a PCOS picture. Each test runs about Rs 400 to Rs 1,000. To understand how these shift across the month, see hormone levels during the cycle and our explainer on luteinising hormone.

Prolactin is a pituitary hormone that, when high, can stop ovulation and cause irregular periods or milk-like discharge. It can be tested any day; normal is usually under 25 to 30 ng/mL. A raised level needs investigation for a cause such as a benign pituitary growth, certain medicines, or an underactive thyroid. Cost is about Rs 400 to Rs 1,000. Our guide to high prolactin explains the workup and treatment.

Thyroid tests (TSH, sometimes free T4 and antibodies) matter because an underactive thyroid disrupts ovulation and is linked to miscarriage. For women trying to conceive, many guidelines favour a TSH below 2.5 mIU/L, which is stricter than the general adult range of about 0.4 to 4.5. TSH costs around Rs 200 to Rs 600; a fuller panel Rs 600 to Rs 2,000. If yours is high, see hypothyroidism and fertility.

Androgens (testosterone, DHEAS, free testosterone, SHBG) are checked mainly in a PCOS workup or when there is excess hair or acne. Individual tests run Rs 400 to Rs 1,200; a panel Rs 1,500 to Rs 4,000. 17-OH progesterone is added if congenital adrenal hyperplasia is suspected (about Rs 800 to Rs 2,000).

Mid-luteal progesterone, drawn about a week after suspected ovulation (around day 21 of a 28-day cycle), confirms that you actually ovulated. A value above 10 ng/mL generally indicates a normal ovulation. Cost is about Rs 300 to Rs 800.

Metabolic and nutritional tests are added selectively: fasting glucose and insulin (with HOMA-IR) in PCOS or suspected insulin resistance, sometimes HbA1c and a lipid profile, and vitamin D, which is deficient in most Indian women. These typically cost Rs 400 to Rs 2,000 each.

Use a lab accredited by NABL, CAP, or ISO 15189 for reliable results. Interpret hormones together and in clinical context, repeat any surprising value, and remember that age colours how every reproductive hormone is read. For a primer on what hormones do, see hormones explained.

Imaging shows the structures that blood tests cannot, your uterus, ovaries, and fallopian tubes. It usually starts simple and only escalates if something needs a closer look.

Transvaginal pelvic ultrasound (TVUS) is the workhorse. With the probe in the vagina it gives a detailed view of the uterus, lining, and ovaries, and is preferred over the abdominal scan for fertility. It can reveal fibroids, polyps, cysts, endometriomas, signs of adenomyosis, and a fluid-filled tube (hydrosalpinx). Timing depends on the question: early cycle for a baseline and follicle count, mid-cycle to watch a follicle grow, late cycle to measure the lining. It takes 15 to 30 minutes and costs about Rs 1,500 to Rs 3,500. If a scan is your first, our guide to your first gynaecologist visit covers what to expect and your right to a chaperone.

Antral follicle count (AFC) is done during that early-cycle scan: the sonographer counts the small resting follicles in both ovaries. A total of about 8 to 25 is typical; under 5 to 7 suggests reduced reserve, while a high count is common in PCOS. AFC and AMH together give a more reliable reserve estimate than either alone, and AFC usually adds no extra cost.

Hysterosalpingography (HSG) is the standard test for tubal patency: contrast dye is injected through the cervix and X-rays show whether the dye flows through and spills from each tube. It is done on days 6 to 10 of the cycle and costs about Rs 2,500 to Rs 8,000. Our HSG tubal patency guide explains how to prepare and what the pictures mean, and the wider issue of blocked or damaged tubes is covered separately.

HyCoSy (sono-HSG) is an ultrasound alternative using saline or foam contrast with no radiation, done at the same visit, but it needs a skilled operator and is less widely available (about Rs 3,000 to Rs 8,000). Saline infusion sonography (SIS) uses saline to outline the cavity and is excellent for spotting polyps, submucosal fibroids, or adhesions (about Rs 3,000 to Rs 6,000).

MRI of the pelvis is reserved for unclear cases and is often the test of choice for adenomyosis and deep endometriosis (about Rs 8,000 to Rs 25,000). Hysteroscopy puts a camera inside the uterus to inspect and often treat polyps, fibroids, or adhesions in the same sitting; see hysteroscopy in India. Laparoscopy with chromopertubation is the most definitive tubal test but is surgical, so it is used selectively; see laparoscopy for women.

Imaging quality depends heavily on the operator and equipment, so choose a centre with genuine fertility-imaging experience, and have the findings read alongside your hormone results and history.

• Volume: 1.5 mL or more
• Concentration: 15 million sperm per mL or more
• Total count: 39 million or more per ejaculate
• Total motility: 40 percent or more (progressive motility 32 percent or more)
• Morphology: 4 percent or more normally shaped (strict criteria)
• Vitality and white cells: most sperm alive, few white blood cells

• PCOS: irregular cycles, raised androgens, high AMH and many follicles; managed with lifestyle change and ovulation induction.
• Tubal damage: often from past pelvic infection or genital TB in India; usually needs surgery in select cases or IVF.
• Uterine cavity issues: fibroids, polyps, a septum, or adhesions, often correctable by hysteroscopic surgery.
• Hormonal disorders: an underactive thyroid or high prolactin, both very treatable and often restoring fertility.
• Male factor: ranges from mild to severe, treated with lifestyle change, medication, IUI, IVF, or ICSI.
• Diminished ovarian reserve: low AMH, high FSH, which affects timing and treatment choice.
• Unexplained infertility: a normal workup in about 10 to 20 percent of couples, with several treatment options still open.

India has a deep, accessible fertility-care network, especially in metros and tier-2 cities, with costs that are modest by global standards but still significant for many families. Knowing the landscape helps you plan and budget.

For lab work, the major chains, SRL Diagnostics, Metropolis Healthcare, Thyrocare, Dr Lal PathLabs, Apollo Diagnostics, and Quest, all offer fertility hormone panels, with NABL or CAP accreditation at the larger ones. A bundled hormonal panel runs about Rs 5,000 to Rs 15,000. For treatment, fertility chains and hospital units (Nova IVF, Indira IVF, Cloudnine, Apollo Fertility, Fortis, Manipal, Birla Fertility, among others) operate nationwide, while government and teaching hospitals such as AIIMS, KEM Mumbai, JIPMER, and CMC Vellore offer high-quality care at a fraction of the cost. Centres affiliated with ISAR (Indian Society for Assisted Reproduction) follow recognised standards.

A realistic budget for a basic couple workup in private care:

Government hospitals can complete the same workup for roughly Rs 2,000 to Rs 8,000. Treatment costs scale up: ovulation-induction medicines Rs 1,000 to Rs 5,000 per cycle plus monitoring, IUI Rs 8,000 to Rs 25,000, IVF Rs 1,50,000 to Rs 4,00,000, ICSI and PGT adding more, and egg freezing Rs 1,50,000 to Rs 3,00,000 plus yearly storage.

Standard Indian health insurance rarely covers fertility evaluation or treatment, though dedicated fertility products and some employer benefits are emerging; most couples self-fund. Budget for the whole journey, not just the first tests, since more than one cycle may be needed, and factor in time off work and travel. Choose a centre on accreditation, the experience of its specialists, the quality of its embryology lab if IVF is likely, and clear communication, not just on advertised success rates, which are measured inconsistently.

Most couples need only the basic workup. Some situations call for a wider net, and knowing about them in advance prevents frustration if your doctor suggests extra tests.

Recurrent pregnancy loss (two or more losses) gets its own evaluation: a detailed cavity check, an antiphospholipid antibody panel, karyotyping of both partners, and testing of pregnancy tissue where possible. Treatment depends on what is found, for example aspirin and low-molecular-weight heparin for antiphospholipid syndrome. See our guide to recurrent miscarriage for the full pathway.

Genital tuberculosis deserves special mention in India, where it is a meaningful cause of tubal infertility. Where it is suspected, an endometrial biopsy for TB testing (including Xpert MTB/RIF), a Mantoux or IGRA test, a chest X-ray, and characteristic HSG findings help confirm it so it can be treated.

Before IVF, expect infection screening (HIV, hepatitis B and C, syphilis) and sometimes extra endometrial or genetic tests. Repeated implantation failure after good embryos may prompt detailed cavity, receptivity, or immune testing. Suspected endometriosis may need MRI or a diagnostic laparoscopy. A very low AMH or high FSH at a young age warrants repeat testing and sometimes a karyotype or Fragile X premutation test.

Cancer survivors and women on gonadotoxic treatment should discuss fertility preservation before further therapy. And many couples now choose pre-conception carrier screening, particularly for thalassaemia, which is more common in some Indian communities, alongside preconception planning for any existing medical condition. Comprehensive evaluation for all of these is available at major fertility and ISAR-affiliated centres.

• You are under 35 and have tried for 12 months, or 35 to 37 and tried for 6 months, without conceiving.
• You are 38 or older and trying, where earlier evaluation protects your options.
• Your periods are irregular, very heavy, very painful, or absent, which may signal an ovulation or structural problem.
• You have a history of pelvic infection, tuberculosis, endometriosis, PCOS, or pelvic or abdominal surgery.
• You have had two or more pregnancy losses, or any ectopic pregnancy.
• You have signs of a hormonal problem: excess facial or body hair, severe acne, or milk-like nipple discharge.
• Your partner has a known fertility issue, a history of testicular problems, or has had cancer treatment.

• WHO laboratory manual for the examination and processing of human semen (6th edition)
• NICE guideline CG156: Fertility problems — assessment and treatment
• American Society for Reproductive Medicine (ASRM) — Diagnostic evaluation of the infertile female
• American Thyroid Association — Guidelines for thyroid disease in pregnancy and preconception
• Indian Society for Assisted Reproduction (ISAR)