Investigation of the Infertile Couple

A Structured, Couple, Focused Medical Evaluation

Infertility evaluation must be medically precise and centered on both partners.
The objective is not simply to identify abnormalities, but to detect correctable factors and guide couples toward the most effective reproductive options  whether natural conception or assisted reproductive techniques.

Fertility is never assessed in isolation. It is approached as a shared biological system, where multiple factors may coexist.

Step 1: Comprehensive Medical History

A detailed medical history is obtained from both partners, forming the foundation of accurate diagnosis and decision-making.

This includes:

• Menstrual cycle characteristics and regularity

• Sexual frequency and timing

• Previous pregnancies, miscarriages, or fertility treatments

• Past surgeries, infections, chronic conditions

• Lifestyle factors (smoking, alcohol, stress, medications, occupational exposures)

Male Evaluation

Semen Analysis

The first-line investigation in male fertility assessment.

It evaluates:

• Sperm concentration

• Motility

• Morphology

• Overall semen quality

Samples are collected after 2–7 days of sexual abstinence.
Repeat testing is often required due to natural variability.

Further Male Testing (If Indicated)

Depending on findings, additional investigations may include:

• Semen culture

• Hormonal evaluation (FSH, LH, testosterone)

• Scrotal ultrasound

• Antisperm antibody testing

• Genetic testing (karyotype, Y-chromosome microdeletions, CFTR gene mutations)

Female Evaluation

Hysterosalpingography (HSG)

An X-ray examination using contrast dye to assess:

• Uterine cavity shape

• Fallopian tube patency

It helps identify blockages, adhesions, or structural anomalies.

Transvaginal Ultrasound

Used to evaluate:

• Ovarian morphology

• Uterine anatomy

• Antral follicle count

Ultrasound is also essential for ovulation monitoring and cycle assessment.

Ovulation & Hormonal Assessment

Ovulatory function is evaluated using a combination of clinical and laboratory tools, including:

• Ovulation predictor kits (LH surge detection)

• Mid-luteal progesterone testing

• Cycle tracking and ultrasound monitoring

• Hormonal panels: FSH, LH, AMH, prolactin, thyroid function, and androgens

These tests provide insight into ovarian reserve, ovulatory status, and endocrine balance.

Genetic Testing (When Appropriate)

Genetic evaluation is recommended in specific scenarios, particularly in cases of severe male infertility or recurrent reproductive failure.

Testing may include:

• Karyotype analysis

• Y-chromosome microdeletion screening

• CFTR gene mutation testing

Genetic findings can influence treatment selection, IVF strategy, and long-term reproductive planning.