Investigations in infertility If a couple is trying to conceive for a certain time fails to start a family, both partners need to do some basic and other advanced investigations. For couples who do not have any comorbidities and are below the age of 35 years and have been trying to conceive for more than one year should meet their fertility consultant and get evaluated. For couples more than 35 years , with or without comorbidities should be evaluated even earlier probably 6 months after failing to conceive. The male partner is evaluated with basic semen analysis examination after atleast 3-5 days of abstinence with the basic WHO guided criteria. Although sperm count per ml and sperm motility are evaluated as a first line investigation other details in the semen analysis like morphology, cellular content, active progressive motility are equally important. If any parameter is out of the normal range values then extended advanced investigations are prescribed. Further evaluation includes sperm DNA fragmentation, culture if suspicion of infection, Ultrasound and Color doppler if motility is hampered due to certain conditions like varicocele. Sperm DNA fragmentation and other vitality tests for sperm give us useful information about the normal DNA make up of the sperms and also throw a light on the stress induced damages. In the female partner normal physiology dictates that in an ovulatory cycle the egg is released from the ovary at timely interval and if the tubes are patent they will carry the egg through them towards the uterus. Normal motile sperms deposited in the lower genital tract travel towards the egg. Only the motile sperms will penetrate the outer covering of the egg and fertilise the ovum. For all these normal mechanisms to function the structural and endocrinological controls have to be normal. So while evaluating a lady focus is on evaluating the components of this cycle. Ovulation or the lack of it is the central event around which the other parameters revolve. Very common problem today of PCOS causes anovulation and the absence or untimely ovulation can lead to problems. This can be studied from early part of the cycle with or without medications with Ultrasonography. USG can give predictive information as to when the ovulation can occur. Although certain hormonal kits like LH kits also give this information , the latter is not prospective and has lower sensitivity. Pelvic Usg is also useful to evaluate the uterus , the inner lining- the endometrium and adnexa. Any tumor of the uterine muscle (fibroid) or an ovarian cyst can cause problems in conceiving and are better evaluated with USG. For the male and the female gametes to meet and fertilise the tubes have to be patent. A blocked tube most likely due to infections or other reasons can cause infertility. Evaluation of tubal patency can be done with Hysterosalpingography (HSG) in which a dye is pushed through the uterus and tubes and patency is confirmed on a X ray or through Hysterolaparoscopy where under anesthesia the uterine cavity and the pelvis is evaluated under direct vision. Hysterolaparaoscopy has the added advantage of treating any problems if they are diagnosed. Last but not the least hormonal evaluation of the lady particularly for the ovarian reserve is very important to judge how much is the capacity of the ovaries to produce normal and adequate oocytes. Sr AMH, FSH, LH and Antral follicle counts are important few investigations amongst many for knowing the ovarian reserve. It is important that the couple get investigated not only to know if there are any problems but also to know how soon they can be tackled. Both partners have to be evaluated when they face problems in conceiving. Each couple has a unique ecosystem for pregnancy and investigations should be done to tailor their needs. Your fertility consultant is the best judge and coordinating with him/her will help you achieve your goal.