Fertility investigation

⚕ Medically reviewed by Prof. Stratis Kolibianakis, MD, MSc, PhD · Thessaloniki Medical Chamber Reg. No. 16340 · Last reviewed 6 July 2026

Investigation is not limited to the couple’s fertility. It is organised around two axes, since a healthy pregnancy presupposes the broader health of the future mother.

1. Investigation of the couple’s fertility. Begins when a couple has not conceived after 12 months of trying — or 6 months if the woman is 35 or older. In the woman: ovarian reserve assessment (AMH via blood test, AFC via ultrasound) and tubal patency check by painless foam hysterosalpingography. In the man: a semen analysis.

2. Health of the future mother. Identifying conditions that can affect pregnancy outcome so they can be addressed before conception — alongside a general preventive check before the start of pregnancy.

Results are discussed with a written summary and a clear plan of next steps.

What to expect, step by step. The first visit is devoted to history: how long you have been trying, your menstrual cycle, previous pregnancies or losses, surgery, medication and family history. You do not need to arrive with tests already done; we use whatever exists and schedule what is missing. The basic female work-up usually fits within one cycle: AMH can be measured on any day, the antral follicle count (AFC) in the first days of the cycle, and hysterosalpingography after the period ends and before ovulation. The semen analysis is done after 2–5 days of abstinence and, if abnormal, is repeated after 3 months before drawing conclusions, because sperm production fluctuates.

Why age and ovarian reserve matter. AMH and AFC do not predict whether you will conceive naturally; they estimate how many eggs remain and help set the right medication dose if IVF becomes necessary. A low AMH in a young woman does not mean you cannot conceive, just as a normal AMH in a woman over 40 does not cancel the effect of age on egg quality. That is why every result is always interpreted together with age and history — never in isolation.

When we move to treatment. When the work-up identifies a clear cause (e.g. blocked tubes, severe male factor, ovulation disorders), the plan follows accordingly. When all tests are normal — unexplained infertility — the choice between expectant management, ovulation induction with insemination, or IVF depends mainly on the woman’s age and the duration of infertility, in line with ESHRE guidance. The aim of the work-up is not to run as many tests as possible, but only those that actually change the decision.

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