Fertility is a highly coordinated biological process influenced by hormonal, genetic, anatomical, and lifestyle factors. Before attempting pregnancy—or beginning any fertility treatment—the most important first step is completing an initial fertility checkup for both partners. This evaluation provides a clear understanding of reproductive health, prevents unnecessary testing, and helps identify potential issues early.

This guide provides a comprehensive overview of what a proper fertility checkup should include, based on recommendations from WHO, ASRM, and ESHRE.

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🩺 Why an Initial Fertility Checkup Matters

Infertility is not always obvious. Many conditions related to fertility show no symptoms and may remain unnoticed for years. Research shows that 50% of infertility cases involve male factors, yet testing often begins only with the woman. A structured, simple checkup helps:

• Identify issues early
• Prevent time loss during the most fertile years
• Avoid unnecessary treatments
• Save money
• Provide a clearer roadmap for conception or assisted reproductive methods

Both partners must undergo this evaluation—fertility is a shared process.

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👩‍🦰 Female Initial Evaluation

A woman’s fertility checkup generally includes three components:

1. Basic hormonal testing
2. Transvaginal pelvic ultrasound
3. Assessment of medical history and menstrual patterns

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1) Basic Hormonal Tests

These tests are typically done on days 2–4 of the menstrual cycle.

● FSH (Follicle-Stimulating Hormone)

Indicates ovarian reserve and how hard the brain works to stimulate the ovaries.

● LH (Luteinizing Hormone)

Important for ovulation assessment and diagnosing conditions such as PCOS.

● TSH (Thyroid Stimulating Hormone)

Thyroid disorders can contribute to infertility, miscarriage, and irregular cycles.

● Prolactin

Elevated levels can suppress ovulation and cause irregular menstruation.

● Estradiol (E2)

Reflects baseline ovarian activity and can influence FSH interpretation.

● AMH (Anti-Müllerian Hormone)

One of the most accurate indicators of ovarian reserve. It shows the approximate number of remaining follicles.

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2) Transvaginal Ultrasound

Pelvic ultrasound is a key component of the checkup and provides detailed information about reproductive anatomy.

It helps evaluate:

• AFC (Antral Follicle Count) — a major marker of ovarian reserve
• Uterus — shape, fibroids, polyps, and congenital anomalies
• Endometrium — thickness and quality
• Ovaries — cysts, PCOS features, endometriomas

This imaging gives doctors a precise understanding of reproductive health without excessive testing.

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👨‍🦱 Male Initial Evaluation

For men, the first and most essential test is a semen analysis, performed according to WHO 2021 standards. This test is simple, cost-effective, and highly informative.

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Parameters evaluated in semen analysis include:

● Volume

Low volume may indicate blockage or glandular issues.

● Concentration (Sperm Count)

Shows the number of sperm per milliliter.

● Total Sperm Count

Important for estimating fertility potential.

● Motility

Progressive motility is crucial for sperm reaching the egg.

● Morphology

Sperm shape (Kruger criteria) influences fertilization ability.

● Vitality

Indicates the percentage of living sperm.

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Important Notes for Male Evaluation

• Heat exposure, tight clothing, smoking, alcohol, obesity, stress, and lack of sleep significantly reduce sperm quality.
• The full sperm production cycle takes 70–90 days. Improvements from lifestyle changes appear after about 3 months.
• Semen analysis should be repeated twice, with 2–4 weeks between tests, to confirm accuracy.

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⭐ Conclusion

The initial fertility checkup is a crucial diagnostic step for all couples planning pregnancy.
It helps:

• Detect problems early
• Avoid unnecessary treatments
• Provide the correct medical direction
• Protect time during the most fertile years

Accurate diagnosis is the foundation of successful fertility care.