Female Fertility Evaluation & Treatment at Yaal Fertility Centre, Chennai

Polycystic ovary syndrome (PCOS) is one of the most common causes of irregular or absent ovulation. It is a hormonal condition, not simply a matter of ovarian cysts, and it can present very differently between women — some with irregular cycles and few other symptoms, others with additional features such as acne, excess hair growth, or weight changes. The unifying problem for fertility is that eggs are not released on a predictable schedule, which makes natural conception harder to time and, in some cases, prevents ovulation altogether.

Thyroid dysfunction — both an underactive and an overactive thyroid — can disrupt the hormonal signalling that governs ovulation and menstrual regularity. It is checked routinely in the female fertility workup because it is common, easily tested for, and often very treatable with medication.

Both conditions are usually managed first with medical treatment aimed at restoring regular ovulation, with more advanced fertility treatment reserved for cases that do not respond or where other factors are also present.

Tubal factor infertility occurs when the fallopian tubes are blocked or scarred, most often as a result of prior pelvic infection, endometriosis, or previous pelvic or abdominal surgery. Because fertilisation normally happens inside the fallopian tube, a blockage can prevent sperm and egg from ever meeting, even when ovulation and the uterus are entirely normal. This is assessed with a hysterosalpingogram (HSG), which uses a small amount of contrast dye and an X-ray to check whether the tubes are open.

Uterine factors affect implantation rather than fertilisation. Fibroids are benign muscular growths in the uterine wall that can, depending on their size and location, distort the uterine cavity or interfere with implantation. Polyps are growths of the uterine lining that can similarly disrupt implantation. Adhesions (scar tissue within the uterine cavity) most often follow prior surgery or infection. A uterine septum is a congenital division of the uterine cavity present from birth. Many of these are correctable with minor surgical procedures once identified, which is why uterine assessment is a standard part of the workup rather than an optional extra.

Every woman is born with a fixed number of eggs, and that number declines steadily with age — it is not replenished. Ovarian reserve refers to the remaining quantity (and, indirectly, the quality) of a woman’s eggs, and it is estimated using a blood test for Anti-Müllerian Hormone (AMH) together with an antral follicle count on ultrasound.

Ovarian reserve declines gradually through the thirties and more steeply from the mid-to-late thirties onward, and this decline is a normal biological process rather than a sign of poor health. A lower-than-expected reserve for a woman’s age is described as diminished ovarian reserve, and it can occur earlier than expected due to genetics, prior ovarian surgery, chemotherapy, or for no identifiable reason at all.

Ovarian reserve testing does not simply confirm a diagnosis — it helps determine timelines. A woman with a lower reserve for her age may benefit from moving to more effective treatment sooner rather than waiting, since the window in which her own eggs remain viable is narrower than average. This topic, and the treatment options for diminished ovarian reserve specifically, are covered in more depth on our dedicated page.

Endometriosis occurs when tissue similar to the lining of the uterus grows outside it, most commonly on the ovaries, fallopian tubes, and pelvic lining. It can cause pain, particularly around periods, though some women have little or no pain despite significant disease, and it is diagnosed definitively by laparoscopy, though ultrasound and clinical history can raise strong suspicion beforehand.

Its effect on fertility varies with severity. Mild endometriosis may have little measurable impact, while more advanced disease can distort pelvic anatomy, damage the fallopian tubes, affect egg quality, and interfere with implantation. Management depends on severity and on how urgently a pregnancy is being pursued, and can range from surgical treatment to moving directly to IVF, which bypasses much of the anatomical disruption endometriosis can cause.

Bringing the pieces together, the standard evaluation typically includes:

• Hormone panel — including FSH, LH, prolactin, and thyroid function, usually drawn early in the menstrual cycle.
• AMH (Anti-Müllerian Hormone) — a blood test that gives a good indication of remaining egg supply and can be drawn at any point in the cycle.
• Pelvic ultrasound — to examine the ovaries and uterus, count antral follicles, and look for fibroids, polyps, or cysts.
• Hysterosalpingogram (HSG) — an X-ray test using contrast dye to confirm the fallopian tubes are open and to outline the uterine cavity.

Not every test is needed for every woman — the history and initial findings guide what is actually necessary. The goal throughout is to identify the specific obstacle to conception, so that the treatment that follows is targeted rather than generic.

The workup exists to answer one practical question: which treatment, out of a fairly wide range, actually fits what has been found? Rather than starting every couple on the same protocol, the findings above are used to place each woman on a treatment pathway that matches the specific obstacle identified.

Where the main issue is ovulatory — irregular or absent ovulation from PCOS or another cause, with open tubes and a normal uterine cavity — treatment usually starts with ovulation induction, paired with either timed intercourse or IUI depending on sperm parameters and how long lower-intensity treatment has already been tried. This is the least invasive route and, for the right diagnosis, often the most successful first step rather than a formality on the way to something else.

Where the workup instead points to tubal blockage, moderate-to-severe endometriosis, a significant male-factor issue, or unexplained infertility that has not responded to simpler treatment, moving more directly to IVF — with ICSI where sperm quality is a factor — is generally the more effective route, since it bypasses the specific obstacle rather than working around it indirectly. Uterine factors such as polyps, submucosal fibroids, or adhesions are often corrected surgically first, regardless of which fertility treatment follows, since an abnormal cavity can undermine an otherwise well-planned cycle.

Several of the causes this evaluation identifies have their own dedicated treatment pathway, which your evaluation may lead you to rather than staying on this page: diminished ovarian reserve has its own protocol considerations, PRP included, on our low ovarian reserve page; recurrent pregnancy loss has a dedicated investigation and management pathway; and PCOS and endometriosis management specifically — beyond the fertility-treatment ladder described here — are covered in depth on our women's health services pages. Dr. Rukkayal will tell you plainly which of these applies once your results are in, rather than leaving you to guess from a generic checklist.