investigations for infertility

Clinical answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Investigations for infertility assessment in women include:

Hysterosalpingography (HSG) to screen for tubal occlusion in women without comorbidities, as it is a reliable and less invasive test .
Hysterosalpingo-contrast ultrasonography as an alternative to HSG where expertise is available .
Diagnostic laparoscopy and dye for women with suspected comorbidities such as endometriosis or pelvic inflammatory disease .
Serum progesterone measurement in the mid-luteal phase (day 21 of a 28-day cycle) to confirm ovulation, especially in women with irregular cycles .
Gonadotrophin measurement (follicle-stimulating hormone and luteinising hormone) in women with irregular cycles to assess ovulation disorders .
Thyroid function tests if symptoms suggest thyroid disease .
Prolactin measurement only if symptoms of ovulatory disorder, galactorrhoea, or pituitary tumour are present .
Assessment of ovarian reserve using tests such as antral follicle count via ultrasound, anti-Müllerian hormone levels, and FSH levels, to predict ovarian response in IVF .

Investigations for infertility assessment in men include:

Semen analysis to evaluate semen volume, pH, sperm concentration, motility, vitality, and morphology, with reference values provided by WHO ,.
Repeat semen analysis if initial results are abnormal, ideally after 3 months ,.
Microbiological tests, sperm culture, endocrine tests, imaging of the urogenital tract, and testicular biopsy may be considered in cases of abnormal semen results .
Screening for antisperm antibodies is not recommended as there is no evidence of effective treatment .

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