Infertility, first consultation
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Woman with regular cycles (after 6 months of intercourse if > 35 years, or 1 year of intercourse if < 35 years)
Laboratory tests on day 21 of the cycle
- Serum progesterone
Laboratory tests
- FBC
- TSH
- HIV serology
- Syphilis serology
- Hepatitis C serology
- Hepatitis B serology (HBsAg, anti-HBs antibodies, anti-HBc antibodies)
- Rubella serology (if vaccination absent or uncertain)if neededNICE (2026) proposes rubella serology for women who consult for infertility and are not vaccinated or do not know if they are, in order to vaccinate those who are not immune, avoiding pregnancy for at least one month after the vaccine [2]. In France, HAS proposes it at the preconception visit, unless two vaccinations are documented [3]; the reference text of the Collège des enseignants d'endocrinologie on the first infertility consultation does not mention it [1].
- Total IgAif neededWhen the work-up finds no cause (normal ovulation, tubes and semen analysis): ESHRE (2023) considers that testing for coeliac disease may be considered in women with unexplained infertility (conditional recommendation) [4], and NICE (2026) proposes considering it according to its coeliac disease guideline, which combines total IgA and IgA anti-transglutaminase antibodies first-line [2,5]. The reference text of the Collège des enseignants d'endocrinologie on the first infertility consultation does not mention it [1]. The result is reliable only if the diet contains gluten during the work-up [5].
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)if neededWhen the work-up finds no cause (normal ovulation, tubes and semen analysis): ESHRE (2023) considers that testing for coeliac disease may be considered in women with unexplained infertility (conditional recommendation) [4], and NICE (2026) proposes considering it according to its coeliac disease guideline, which combines total IgA and IgA anti-transglutaminase antibodies first-line [2,5]. The reference text of the Collège des enseignants d'endocrinologie on the first infertility consultation does not mention it [1]. The result is reliable only if the diet contains gluten during the work-up [5].
+ on self-collected sample or first-catch urine
- Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR)
- Mycoplasma genitalium NAAT (PCR)if neededOnly with symptoms of lower genital tract infection (cervicitis), recurrent or persistent, or an infected partner. HAS advises against this test as screening in an asymptomatic woman.
- (These PCRs can be done on oropharynx or rectum depending on sexual practices)
Do not order
- Post-coital test: not recommended in unexplained infertility [4]; its value is "much debated" according to the CEEDMM [1].
- Endometrial biopsy, antithyroid antibodies and other autoimmune markers (apart from coeliac disease), thrombophilia screen, vitamin D measurement: not recommended in unexplained infertility [4].
- Looking for antisperm antibodies in serum (man or woman): not recommended in unexplained infertility [4].
- AMH: judged unnecessary in the infertility work-up by the CEEDMM [1]; ESHRE does not consider it required in a woman with regular cycles [4].
Woman with irregular cycles (after 6 months of intercourse if > 35 years, or 1 year of intercourse if < 35 years)
Laboratory tests to be done on day 21 of the cycle
- Serum progesterone
Laboratory tests to be done on day 3 of the cycle
- FSH
- LH
- Serum prolactin
- Oestradiol
- 17-hydroxyprogesterone, testosterone and DHEA-S if dysovulation and signs of hyperandrogenismif neededIf ovulation disorder and signs of hyperandrogenism.
Laboratory tests
- FBC
- Fasting plasma glucose
- TSH
- HIV serology
- Syphilis serology
- Hepatitis C serology
- Hepatitis B serology (HBsAg, anti-HBs antibodies, anti-HBc antibodies)
- Rubella serology (if vaccination absent or uncertain)if neededNICE (2026) proposes rubella serology for women who consult for infertility and are not vaccinated or do not know if they are, in order to vaccinate those who are not immune, avoiding pregnancy for at least one month after the vaccine [2]. In France, HAS proposes it at the preconception visit, unless two vaccinations are documented [3]; the reference text of the Collège des enseignants d'endocrinologie on the first infertility consultation does not mention it [1].
+ on self-collected sample or first-catch urine
- Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR)
- Mycoplasma genitalium NAAT (PCR)if neededOnly with symptoms of lower genital tract infection (cervicitis), recurrent or persistent, or an infected partner. HAS advises against this test as screening in an asymptomatic woman.
- (These PCRs can be done on oropharynx or rectum depending on sexual practices)
Do not order
- Post-coital test: not recommended in unexplained infertility [4]; its value is "much debated" according to the CEEDMM [1].
- Endometrial biopsy, antithyroid antibodies and other autoimmune markers (apart from coeliac disease), thrombophilia screen, vitamin D measurement: not recommended in unexplained infertility [4].
- Looking for antisperm antibodies in serum (man or woman): not recommended in unexplained infertility [4].
- AMH: judged unnecessary in the infertility work-up by the CEEDMM [1]; ESHRE does not consider it required in a woman with regular cycles [4].
Man (after 6 months of intercourse if > 35 years, or 1 year of intercourse if < 35 years)
Fasting laboratory tests between 7 am and 11 am
- Total testosterone
- LH
- FSH
- Prolactinif neededDecreased libido with sexual dysfunction, unexplained gynaecomastia, or hypogonadotropic hypogonadism.
- Request a semen analysis
Do not order
- When the semen analysis (WHO criteria) is normal: serum hormone measurements, testicular imaging, antisperm antibodies in semen, sperm DNA fragmentation, semen microbiology: not recommended (unexplained infertility) [4].
- Post-coital test: not recommended in unexplained infertility [4]; value "much debated" according to the CEEDMM [1].
Sources (11)
- Infertilité du couple : conduite de la première consultation
- National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE guideline NG257, 31 March 2026 (remplace CG156).
- Haute Autorité de santé. Projet de grossesse : informations, messages de prévention, examens à proposer. Document d'information pour les professionnels, septembre 2009.
- ESHRE Guideline Group on Unexplained Infertility (Romualdi D, Ata B, Bhattacharya S, et al.). Evidence-based guideline: unexplained infertility. Hum Reprod 2023;38(10):1881-1890.
- National Institute for Health and Care Excellence. Coeliac disease: recognition, assessment and management. NICE guideline NG20, 2 September 2015.
- Practice Committee of the American Society for Reproductive Medicine. Definition of infertility: a committee opinion. Fertil Steril 2023;120(6):1170.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105, acte 0793 (hormone anti-müllérienne).
- Direction des affaires juridiques de l'AP-HP. Arrêté du 2 juin 2014 modifiant l'arrêté du 3 août 2010 modifiant l'arrêté du 11 avril 2008 relatif aux règles de bonnes pratiques cliniques et biologiques d'assistance médicale à la procréation (résumé).
- Phillips K, Olanrewaju RA, Omole F. Infertility: Evaluation and Management. Am Fam Physician. 2023;107(6):623-630.
- Stérilité du couple : conduite de la première consultation
- Jones C A, Kulshreshtha A, Born K, Katiyar P. Initial assessment of infertility in primary care BMJ 2025; 390 :e079609 doi:10.1136/bmj-2024-079609