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Concierge fertility care · London

Fertility investigation, the structured workup for female, male and couple subfertility — NICE-aligned pathway.

A structured fertility investigation combines hormone testing, ovarian reserve assessment, pelvic ultrasound, tubal patency, semen analysis and genetic screening. Modern private pathway offers rapid, integrated workup for female, male and couple subfertility — with clear next-step planning.

See what it shows
A fertility specialist consulting with a couple in a private London clinic

Key facts

  • 01

    Definition

    A structured, NICE-aligned couple fertility workup covering female, male and shared factors.

  • 02

    Female workup

    Day-2 FSH, LH, AMH and oestradiol, pelvic ultrasound and tubal patency testing.

  • 03

    Male workup

    Semen analysis with reproductive hormone panel where indicated.

  • 04

    Couple screening

    Rubella, karyotype, HIV / hepatitis B and C and cystic fibrosis carrier screening.

  • 05

    Treatment planning

    IVF or IUI planning based on the combined female, male and couple results.

  • 06

    Multi-disciplinary team

    Reproductive endocrinology, andrology, embryology and counselling in one team.

How it works

From first consultation to MDT plan — what happens, in order.

One structured workup, one team — from first consultation to a written multi-disciplinary plan.

  1. 01

    Before

    Fertility specialist consultation

    A structured first consultation with a fertility specialist to map the couple’s pathway.

  2. 02

    Before

    Detailed history and lifestyle review

    Cycle, medical, surgical, sexual and lifestyle history for both partners, with modifiable-risk review.

  3. 03

    Investigations

    Female hormone panel

    Day-2 FSH, LH, AMH and oestradiol, with a luteal-phase progesterone to confirm ovulation.

  4. 04

    Investigations

    Pelvic ultrasound with AFC

    Transvaginal pelvic ultrasound with antral follicle count and uterine cavity assessment.

  5. 05

    Investigations

    Tubal patency

    HyCoSy, HSG or laparoscopy and dye to confirm the fallopian tubes are open.

  6. 06

    Investigations

    Semen analysis

    Semen analysis after 2–5 days of abstinence, with repeat if abnormal.

  7. 07

    After

    MDT review and personalised plan

    Multi-disciplinary team review of all results, with a written personalised plan.

Typical end-to-end: 4–8 weeks. Urgent slots: next cycle.

What it shows

When a fertility investigation is the right workup.

A fertility investigation answers a specific set of questions — is she ovulating, are the tubes open, is the cavity clear, is the sperm normal, and are there shared genetic or infection factors to plan around.

  • Ovarian reserve (AMH, AFC)

    Anti-Müllerian hormone and antral follicle count as the paired reserve markers.

  • Ovulation confirmed / anovulation

    Whether cycles are ovulatory, or whether anovulation is driving subfertility.

  • PCOS pattern

    The Rotterdam criteria pattern of oligo-anovulation, hyperandrogenism and polycystic ovaries.

  • Tubal patency status

    Whether the fallopian tubes are patent on HyCoSy, HSG or laparoscopy and dye.

  • Uterine cavity abnormalities

    Polyps, submucosal fibroids, adhesions or a septate uterus that reduce implantation.

  • Male factor (semen analysis)

    Concentration, motility and morphology against WHO 2021 reference ranges.

  • Genetic screening results

    Karyotype, cystic fibrosis carrier status and Y-chromosome microdeletions.

  • Red flag: severely low AMH or azoospermia — urgent MDT and consider donor pathway

    Very low ovarian reserve or absence of sperm needs urgent MDT review and a candid donor discussion.

Treatment options

What a fertility investigation makes possible.

The pathways a completed workup is designed to support — from lifestyle change and timed cycles through to IVF, ICSI and preservation.

  • Lifestyle advice

    Weight optimisation, alcohol reduction and folic acid supplementation as the baseline for every couple.

  • Timed intercourse cycle

    Natural or lightly-supported cycle with intercourse timed to ovulation.

  • Ovulation induction

    Letrozole or clomiphene to induce ovulation in anovulatory cycles.

  • IUI

    Intrauterine insemination — prepared sperm placed into the uterus around ovulation.

  • IVF / ICSI

    In-vitro fertilisation, with intracytoplasmic sperm injection for male factor.

  • PGT-A / PGT-M

    Pre-implantation genetic testing for aneuploidy or monogenic disorders.

  • Fertility preservation

    Egg freezing for medical or elective indications.

  • Multi-disciplinary team review

    Reproductive endocrinology, andrology, embryology and counselling in one team.

Red flags and safety

What we watch for — and what changes the plan.

A fertility investigation is a safe process, but specific findings materially change the pathway. These are the flags the MDT builds the plan around.

  • Severely low AMH

    Very low ovarian reserve changes urgency and the whole treatment plan.

  • Azoospermia

    Absence of sperm in the ejaculate — urgent andrology and genetic review.

  • Bilateral tubal occlusion

    Both fallopian tubes blocked — IVF is usually the first-line route.

  • Endometriosis with severe pain

    Severe pelvic pain with imaging findings — laparoscopic assessment often needed.

  • PCOS with metabolic syndrome

    Insulin resistance and metabolic risk that need addressing alongside fertility.

  • Premature ovarian insufficiency

    Ovarian failure before 40 — urgent endocrinology and donor egg discussion.

  • Y-chromosome microdeletions

    Genetic cause of severe oligospermia or azoospermia with inheritance implications.

  • Balanced translocation

    Chromosomal rearrangement causing recurrent miscarriage — PGT-M consideration.

  • Recurrent implantation failure

    Multiple failed transfers of good-quality embryos — specialist workup.

Reading your report

A fertility-investigation report can look intimidating. It isn’t.

Whatever the finding, the report keeps to the same four parts.

A consultant reviewing fertility investigation results on a clinical workstation in Central London

A quiet reminder

The report is written for your fertility team, not for you — and that’s normal.

If you would like us to talk you through it before your follow-up, just ask.

  1. 01 Header

    Couple context and history

    Both partners’ details, cycle information, prior treatments and modifiable risk factors that frame interpretation.

  2. 02 Technique

    Investigations performed

    Hormone panels, imaging, tubal patency test and semen analysis — with the standards used for each.

  3. 03 Findings

    Female, male and couple results

    Ovarian reserve, ovulation, cavity and tubal findings, semen parameters and genetic screening results.

  4. 04 Impression

    The MDT conclusion: read this first

    A single-paragraph summary of the diagnosis and the recommended pathway — read this first.

Sources

Clinically referenced.

Last reviewed 2026-07-30. Next review due 2027-07-30. Reviewer: Pulse Atlas Editorial Board, .

Frequently asked

Everything we get asked about fertility investigation.

Quick answers on when to start, what each partner is tested for, and how long the full workup takes.

  • What is a fertility investigation?

    A structured, NICE-aligned workup for couples with subfertility. It combines female hormone testing and pelvic ultrasound with tubal patency assessment, semen analysis for the male partner and shared couple screening (rubella, karyotype, HIV / hepatitis B and C, cystic fibrosis carrier status).

  • When should we start investigations?

    NICE recommends investigation after 12 months of regular unprotected intercourse without conception — or earlier (typically at 6 months) if the female partner is 36 or over, or if there is a known risk factor such as irregular cycles, prior pelvic surgery, endometriosis or a known male-factor risk.

  • What tests does the female partner have?

    A day-2 hormone panel (FSH, LH, AMH, oestradiol), a mid-luteal progesterone to confirm ovulation, a transvaginal pelvic ultrasound with antral follicle count, and a tubal patency test — HyCoSy, HSG or laparoscopy and dye.

  • What tests does the male partner have?

    A semen analysis after 2–5 days of abstinence, assessed against WHO 2021 reference ranges. If abnormal, the test is repeated and a reproductive hormone panel (FSH, LH, testosterone) is added, with genetic testing (karyotype, Y-chromosome microdeletions, cystic fibrosis) if severe.

  • What is tubal patency and how is it tested?

    Tubal patency means the fallopian tubes are open, so an egg can meet sperm. It’s tested with HyCoSy (ultrasound with contrast), HSG (X-ray with contrast) or laparoscopy and dye — the choice depends on your history and what else needs looking at.

  • How long does the full workup take?

    The core female workup fits inside a single menstrual cycle. With semen analysis, genetic screening and MDT review, most couples complete their investigation and have a written plan within 4–8 weeks.

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In practice, in London

Booking fertility investigation privately in London — what actually happens

With fertility investigation, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for fertility investigation vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.

In practice, a private fertility investigation appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For fertility investigation specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see fertility investigation — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.

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