Infertility: assessment & investigation — NICE NG257 (2026), WHO 6th-edition semen criteria, and the structured couple workup

Also known as Subfertility · Infertility investigation · Couple infertility · Fertility workup · Assisted reproduction referral

FRANZCOG fellowship topic on the assessment and investigation of fertility problems, anchored to NICE NG257 (2026): when to investigate, the chance of conception by age, lifestyle advice, semen analysis against WHO reference values, ovulation and ovarian reserve testing, tubal and uterine assessment, the male genetic tests, the tests NICE says not to do, management of unexplained and male-factor problems, and fertility preservation.

high23 referencesUpdated 28 July 202610 min readSource-verified · Oct 2026

Checked against its sources on 23 Oct 2026

Practise this topic

8 MCQs

Scenario

A 34-year-old woman and her 36-year-old partner come to clinic after 14 months of trying to conceive. Her cycles are regular at 28 days, his BMI is 29, and neither has had any investigation. The examiner wants to hear when investigation is justified, which tests you order for each partner, which tests you avoid, and how you counsel them about their chances.

References23Show

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[16]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Defining infertility and initial assessment NICE guideline NG257, 2026.Source
[17]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Investigation of fertility problems and management strategies NICE guideline NG257, 2026.Source
[18]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Initial advice to people concerned about delays in conception NICE guideline NG257, 2026.Source
[19]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Advice about factors that can affect fertility NICE guideline NG257, 2026.Source
[20]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Unexplained fertility problems in people trying to conceive through unprotected vaginal sexual intercourse NICE guideline NG257, 2026.Source
[21]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Management of male factor fertility problems NICE guideline NG257, 2026.Source
[22]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Fertility preservation for medical indications NICE guideline NG257, 2026.Source
[23]National Institute for Health and Care Excellence Fertility problems: assessment and treatment (NG257). Terms used in this guideline NICE guideline NG257, 2026.Source