When pregnancy does not happen, the fastest route to understanding the problem is usually to investigate both partners rather than sequentially testing one person at a time.
Start With the History
Good fertility assessment begins with medical history.
For women this includes:
- Menstrual cycles
- Previous pregnancies
- Pelvic surgery
- Endometriosis
- Previous infections
- Medical conditions
For men it includes:
- Previous testicular problems
- Surgery
- Medications
- Testosterone exposure
- Cancer treatment
- Sexual and ejaculatory function
Female Assessment
Ultrasound
Pelvic ultrasound provides information about the uterus, ovaries and antral follicle count.
Ovarian Reserve
AMH may help estimate ovarian reserve and expected response to fertility treatment.
Ovulation
Menstrual history often provides valuable information.
Additional hormonal testing can be used where ovulation is uncertain.
Fallopian Tubes
Where appropriate, testing may assess whether the fallopian tubes are open.
The exact method depends on clinical circumstances.
Male Assessment
A semen analysis is usually the starting point.
If significant abnormalities are identified, further assessment may include:
- Hormone tests
- Examination
- Ultrasound
- Genetic testing
Preconception Health
Both partners should also review:
- Smoking
- Alcohol
- Weight
- Medications
- Vaccination status where relevant
- Family history
- General medical conditions
Avoid Unnecessary Testing
More tests do not necessarily mean better fertility care.
Some investigations marketed directly to fertility patients have limited evidence that they change treatment or improve live-birth rates.
Testing should answer a clinical question.
The Take-Home Message
A fertility assessment should generally consider eggs, ovulation, sperm, fallopian tubes, the uterus and the couple’s overall reproductive health.
Investigating both partners at the beginning can save time and lead to a more rational treatment plan.
