Investigation

General considerations:

• remember that infertility may be multi-factorial
• rate of conception decreases with age - due to both decreased frequency of intercourse and to poorly defined effects on fertility
• start with relatively simple, non-invasive tests; delay operative evaluation for the first 6 - 8 months

Investigations may include:

• history and examination of both partners
• semen analysis
• assessment of ovulation - mid-luteal progesterone - taken seven days prior to menses e.g. day 21 of 28 day cycle or day 25 of 32 day cycle; other methods include basal body temperature, endometrial biopsy
• other hormonal tests - LH, FSH, TFT's, testosterone, DHEA, sex hormone binding globulin, PRL - performed on day 2, 3 or 4 of cycle
• assessment of cervical compatibility - post coital test, mucus invasion test
• assessment of tubal patency - hysterosalpingography, laparoscopy
• assessment of pelvic adhesions, endometriosis - laparoscopy
• rubella status - this should be checked prior to the commencement of any treatment; if a patient is non-immune then they should be vaccinated and advised to avoid pregnancy for 3 months