How is subfertility investigated?

Investigate the couple together. Core tests:

• Male: semen analysis (count, motility, morphology)
• Female ovulation: mid-luteal (day-21) progesterone (+/- hormone profile)
• Tubal patency: hysterosalpingography (HSG) or laparoscopy and dye

Plus a history/examination, rubella/chlamydia screening, and ovarian reserve testing where relevant.

Clinical relevance. A structured work-up (semen analysis, mid-luteal progesterone, tubal patency) identifies the cause of subfertility to direct treatment.

More Detail

Investigation of subfertility

Investigation targets the three main areas: sperm, ovulation, and tubes.

Approach

• Assess both partners together, with a history and examination of each.

Male factor

• Semen analysis - sperm concentration, motility, and morphology (repeat if abnormal).

Ovulation

• Mid-luteal (day-21 in a 28-day cycle) serum progesterone to confirm ovulation.
• If anovulatory - FSH/LH, oestradiol, prolactin, thyroid function, androgens to find the cause.

Tubal patency

• Hysterosalpingography (HSG) or hystero-contrast sonography (HyCoSy).
• Laparoscopy and dye test - especially if tubal disease/endometriosis is suspected (also therapeutic).

Other

• Chlamydia screening (tubal damage), rubella immunity, and ovarian reserve testing (AMH/antral follicle count) where relevant.
• Pelvic ultrasound (uterine/ovarian anatomy).