Before any treatment comes a diagnosis. What a complete, evidence-based fertility workup covers for both partners — and why it can save you from unnecessary IVF.
✍️ By Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG — Reproductive Medicine Specialist · Updated August 2026
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse. But that definition comes with important exceptions — waiting a full year is not always the right advice:
Roughly one-third of infertility involves female factors, one-third male factors, and the rest is combined or unexplained. Treating without a diagnosis means guessing. A structured workup often reveals a specific, fixable problem — a uterine anomaly, a blocked tube, an ovulation disorder, a treatable sperm issue — and sometimes shows that a couple doesn't need IVF at all.
At LIFE by Dr. Pat, both partners are evaluated in parallel — infertility is a couple's diagnosis, not one person's. A complete workup covers:
Menstrual pattern, previous pregnancies, surgeries, medical conditions, medications, and lifestyle factors for both partners.
AMH blood level plus an antral follicle count on ultrasound — together these estimate egg quantity and help plan treatment intensity.
Thyroid function, prolactin, and cycle hormones where indicated, to detect ovulation disorders such as PCOS or thyroid-related subfertility.
A detailed structural scan of the uterus and ovaries. In my published research, about 27% of infertility patients have a dysmorphic (T-shaped) uterine cavity that standard 2D scans miss. Read about 3D-TVUS + SIS.
Checking whether the fallopian tubes are open, using saline-contrast sonography or HSG — essential before deciding between natural conception, IUI, and IVF.
Sperm concentration, motility, and morphology assessed against WHO reference values. Male factors contribute in roughly half of all couples. More on male-factor evaluation.
If imaging suggests a cavity problem — a polyp, adhesions, a septum, or a dysmorphic cavity — no-touch digital hysteroscopy lets us look inside the uterus directly and often treat in the same setting.
The evaluation typically completes within one menstrual cycle. You then sit down with me — the same physician who performed your scans — and we review the findings together. The plan follows the diagnosis:
Book a Consultation Virtual Consult from Abroad
After 12 months of trying if the female partner is under 35, after 6 months if 35 or older, and immediately at any age if there are warning signs such as irregular periods, known endometriosis, previous pelvic surgery, repeated miscarriage, or a known sperm problem.
For the female partner: AMH and hormonal blood tests, a 3D transvaginal ultrasound of the uterus and ovaries, and a tubal patency check. For the male partner: a semen analysis against WHO reference values. Hysteroscopy is added when imaging suggests a problem inside the uterine cavity.
Most couples complete the full workup within a single menstrual cycle. Several tests can be done on the first visit; a few are timed to specific cycle days.
Yes — in roughly 10–30% of couples no single cause is found after a complete workup. "Unexplained" doesn't mean untreatable: options from timed conception to IUI and IVF are discussed with honest, age-specific success figures.
No. An evaluation at LIFE by Dr. Pat comes with a written summary of findings that you're free to take anywhere. Many patients use it for a second opinion — and many come to us for exactly that reason.
Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG is a board-certified reproductive endocrinology & infertility specialist, former head of the Vajira IVF unit at Navamindradhiraj University, and founder of LIFE by Dr. Pat in Bangkok. His published research focuses on the dysmorphic (T-shaped) uterus and uterine-factor infertility.
Meet Dr. Patsama →