Age of the women: Fertility starts declining when women’s age is >35 years. The quality and number of eggs a woman has decreases throughout her lifetime and egg loss accelerates around the age of 37, which makes it more difficult to become pregnant.

Duration of fertility issues is noted and any prior treatment / tests are noted.Fertility declines significantly after 2 years of trying naturally.

Sexual history: Frequency of intercourse, fear of having sex, problems with desire, pain during intercourse or bleeding after intercourse. Having intercourse once in every 2 or 3 days will cover the fertile days.

Menstrual history: Any delayed or irregular periods, painful periods, heavy periods, bleeding in between the periods, bleeding after intercourse should be evaluated. Periods happening after 35 days is a delayed periods. In women with PCOS with delayed periods, egg release or ovulation may not happen and women should not delay in consulting a fertility specialist if planning for pregnancy.

Medical problems like diabetes, hypertension, tuberculosis and endocrine problems like thyroid and prolactin tumors are noted.

Family history of fertility problemslike premature menopause is noted.

Any previous surgeries for ovarian cyst / tumor, ovarian drilling, surgery for endometriosis, fibroids, polyps, or hydrosalphynx are noted.Also stress, anxiety and sleep disorders are job related and noted.

Physical examination should include assessment of height, weight, Blood pressure, Thyroid, Breast examination, body habitus and general appearance.Examination of pelvis: To know the Uterus size, position, mobility, any palpable mass or any pain during examination.

a)  Health assessment: We check your height and weight to measure your Body Mass Index (BMI). A high (>27) or low BMI (<18) can affect your fertility and reduce your chance of getting pregnant, both naturally and through IVF. We advise you to raise or lower your BMI to improve your chances of conception by losing or gaining weight. Blood pressure is alsochecked.

b)  To check Egg reserve: AMH blood testgives us a good indication of how many eggs are remaining in the ovary, otherwise known as ovarian or egg reserve. AMH blood test can be performed at any time in your menstrual cycle. FSH, LH & Estradiol blood tests are done only on day2 or day3 of the periods.

c)  Other blood tests: Basic routine investigations are done like Hemoglobin, Blood group, Random blood sugar, Prolactin, Thyroid hormones (mainly TSH).

Serology blood tests like HIV, HbsAg and HCV to rule out viral infections.

d)  Pelvic ultrasound scan:  We perform a transvaginal ultrasound scan of your UTERUS and ovaries to check for anything that could affect conception and embryo implantation. An internal scan is a painless procedure and gives us accurate and detailed information about uterus, endometrium, ovaries and any other abnormalities like endometriosis, fibroids or adenomyosis. Antral Follicle Count (egg reserve) will be checked at the same time. Timing of the ovulation can also be made out if scan is done around the time of ovulation.

1. HysteroSalpingoGraphy (HSG): The HSG procedure involves taking an x ray after pushing dye inside the uterus and the tubes. It must be performed between 5^th day and 10^th day of the periods. HSG is done to check the shape of the uterus and mainly to check if there is any blockage in the fallopian tubes.

If all the results are normal, couple can try naturally for up to 2 years to achieve higher chance of pregnancy. However couple can start with fertility treatment after one year of trying for pregnancy.