Basic Couple Information

Female age (years)

Male age (years)

Infertility duration (months)

Type of infertility

Coital frequency (per week)

Prior pregnancy

Intercourse timing

Lubricant use

Ethnicity / Region

Female Age

Optimal

≤34 yrs

Duration

≥12 months

Meets definition

Coital Frequency

Adequate

Target 2–3×/week

Ovarian Reserve Assessment

AMH (ng/mL) — normal 1.1–3.5

AFC — total both ovaries (normal 7–19)

Day 2–3 FSH (mIU/mL) — normal <10

Day 2–3 LH (mIU/mL)

Day 2–3 Estradiol E2 (pg/mL) — normal <80

LH : FSH ratio (auto-calculated)

POSEIDON classification · ESHRE poor responder criteria · FOGSI ovarian reserve guidelines

Ovulation & Hormones

Cycle length (days) — normal 21–35

Cycle regularity

Midluteal progesterone (ng/mL) — normal ≥10

TSH (mIU/L) — fertility target 1–2.5

Prolactin (ng/mL) — normal <25

Follicular tracking result

Anatomical Assessment

HSG (tubal patency)

Hysteroscopy

Laparoscopy

Transvaginal USS

Endometrial thickness (mm)

Uterine anomaly (3D USS / MRI)

ASRM uterine classification · EFI endometriosis score · FOGSI tubal factor guidelines

Semen Analysis — WHO 2021 Reference Values

Volume (mL) — normal ≥1.4

Concentration (M/mL) — normal ≥16

Total motility % — normal ≥42

Progressive motility % — normal ≥30

Normal morphology % (Kruger) — normal ≥4

Total sperm count (M/ejac) — normal ≥39

Vitality % — normal ≥54

pH — normal ≥7.2

Abstinence period (days) — normal 2–7

WHO Laboratory Manual 6th Edition 2021 · FOGSI male factor infertility guidelines

Male Clinical & Hormones

Scrotal ultrasound

FSH — male (mIU/mL) — normal 1.5–12.4

Total testosterone (ng/dL) — normal ≥300

Advanced Male Factor Tests

DNA Fragmentation Index % (DFI) — normal <15%

DFI method

Anti-sperm antibodies (ASA)

ROS (reactive oxygen species)

Karyotype / Y-chromosome

CFTR mutation

Advanced Female & Immunological Tests

ERA (Endometrial Receptivity Array)

Anti-phospholipid antibodies (APLA)

Chronic endometritis (CD138 biopsy)

Uterine NK cells (biopsy)

Vitamin D (ng/mL) — target ≥30

Genital TB screening (India — FOGSI 2022)

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Protocols: ESHRE 2023 · ASRM 2023 · FOGSI 2022 · WHO 2021 · NICE NG156

Evidence-Based Treatment Pathway

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ART Decision Tool

IUI cycles completed

IUI outcome

Patient preference

NICE NG156 · ESHRE guideline · FOGSI ART 2022 · ASRM 2023

Lifestyle & Adjunctive Measures

For both partners

BMI target: 18.5–24.9 kg/m²

Folic acid 400–800 mcg/day (female)

Stop smoking, alcohol, recreational drugs

Vitamin D if deficient (very common in India)

CoQ10 supplementation (both partners)

Female-specific

Thyroid: target TSH 1–2.5 mIU/L (FOGSI)

Inositol if PCOS features present

Avoid NSAIDs near ovulation (LUF risk)

Male-specific

Antioxidants: Vit C + E + zinc + selenium

If DFI elevated: ICSI + antioxidants

International Protocol Summaries

ESHRE 2023 — European Society of Human Reproduction and Embryology ▾

Definition

≥12 months regular unprotected intercourse with no identifiable cause after standard evaluation: ovarian reserve, tubal patency, semen analysis.

Minimum workup

Ovulation confirmation · Tubal patency (HSG/HyCoSy) · Semen analysis (WHO 2021) · Ovarian reserve (AMH + AFC). Laparoscopy only if clinical suspicion.

Treatment sequence

1. Expectant management (<35 yrs, <3 yrs) · 2. IUI ± mild OS · 3. IVF

ASRM 2023 — American Society for Reproductive Medicine ▾

Key guidance

IUI + ovarian stimulation is first-line ART. IVF after 3–6 failed IUI cycles or age ≥38. PGT-A can identify embryonic aneuploidy as occult cause.

FOGSI 2022 — India-Specific Recommendations ▾

Indian context

12 months (<35 yrs) / 6 months (≥35 yrs). Genital TB screening (CB-NAAT / endometrial culture) in high-endemic areas. High Vit D deficiency prevalence.

Treatment sequence

Letrozole/Clomiphene + timed IC → IUI (3–6 cycles) → IVF/ICSI.

NICE NG156 — UK Guidelines ▾

Key points

IVF offered after ≥2 years unexplained infertility. NICE does NOT recommend IUI as first-line — favours expectant → IVF directly. 3 full IVF cycles on NHS.

WHO 2021 — Semen Analysis Reference Values ▾

Parameter	Lower Reference Limit
Volume	≥1.4 mL
Concentration	≥16 million/mL
Total motility (PR+NP)	≥42%
Progressive motility (PR)	≥30%
Normal morphology (Kruger)	≥4%
Total sperm count	≥39 million/ejaculate
Vitality	≥54%
pH	≥7.2

Protocol Comparison Table

Aspect	ESHRE 2023	ASRM 2023	FOGSI 2022	NICE NG156
Duration <35 yrs	12 months	12 months	12 months	12 months
Duration ≥35 yrs	6 months	6 months	6 months	6 months
Tubal assessment	HSG / HyCoSy	HSG preferred	HSG / Lap	HSG / HyCoSy
First-line ART	IUI ± OS	IUI + OS	OI + IC / IUI	Expectant → IVF
TB screening	Not mentioned	Not mentioned	Recommended	Not mentioned
DFI testing	Not routine	Selected cases	Recommended	Not recommended

Clinical Calculators

Weight (kg)

Height (cm)

Unexplained Infertility — Diagnostic & Analysis Tool