What initial investigations should I perform for a couple presenting with infertility after one year of unprotected intercourse?

Initial investigations for a couple presenting with infertility after one year of unprotected intercourse should include simultaneous assessment of both partners.

For the male partner, a semen analysis should be arranged with clear instructions on sample collection (masturbation into a clean, non-toxic container, after 2-7 days of abstinence, ideally near the laboratory to avoid temperature fluctuations and delay in analysis).

If the first semen analysis is normal, no repeat test is needed; if abnormal, a repeat test should be done ideally 3 months later, or sooner if severe abnormalities are found.

For the female partner, a blood test to measure serum progesterone in the mid-luteal phase (day 21 of a 28-day cycle) should be offered to confirm ovulation, even if menstrual cycles are regular.

Women with irregular or prolonged cycles may require repeated progesterone measurements and gonadotrophin (FSH and LH) levels to identify ovulation disorders.

Screening for Chlamydia trachomatis should be performed before any uterine instrumentation, with appropriate management if positive.

Women without known comorbidities (e.g., pelvic inflammatory disease, endometriosis, previous ectopic pregnancy) should be offered hysterosalpingography (HSG) or hysterosalpingo-contrast ultrasonography to assess tubal patency.

Women with suspected comorbidities should be offered diagnostic laparoscopy with dye to assess tubal and pelvic pathology simultaneously.

Routine tests not recommended include endometrial biopsy, basal body temperature charts, ovulation predictor kits, and postcoital testing of cervical mucus.

Both partners should be investigated simultaneously to categorize the cause of infertility and to guide further management.

Early referral and investigations may be considered if the woman is aged 36 years or older or if there are known risk factors for infertility.

Counselling should be offered before, during, and after investigations to address psychological stress related to infertility.

These recommendations are based on NICE guidelines and related UK clinical guidance.

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