investigations for infertility

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 (NICE, 2017a)¹.
• Hysterosalpingo-contrast ultrasonography as an alternative to HSG where expertise is available (NICE, 2017a)¹.
• Diagnostic laparoscopy and dye for women with suspected comorbidities such as endometriosis or pelvic inflammatory disease (NICE, 2017a)¹.
• Serum progesterone measurement in the mid-luteal phase (day 21 of a 28-day cycle) to confirm ovulation, especially in women with irregular cycles (NICE, 2017a)¹.
• Gonadotrophin measurement (follicle-stimulating hormone and luteinising hormone) in women with irregular cycles to assess ovulation disorders (NICE, 2017a)¹.
• Thyroid function tests if symptoms suggest thyroid disease (NICE, 2017a)¹.
• Prolactin measurement only if symptoms of ovulatory disorder, galactorrhoea, or pituitary tumour are present (NICE, 2017a)¹.
• 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 (NICE, 2017a)¹.

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 (NICE, 2017a)¹,².
• Repeat semen analysis if initial results are abnormal, ideally after 3 months (NICE, 2017a)¹,².
• Microbiological tests, sperm culture, endocrine tests, imaging of the urogenital tract, and testicular biopsy may be considered in cases of abnormal semen results (NICE, 2017a)¹.
• Screening for antisperm antibodies is not recommended as there is no evidence of effective treatment (NICE, 2017a)¹.