We speak of infertility after 12 months of regular, unprotected intercourse without pregnancy. For women over 35 it is advised to seek help after 6 months of trying to conceive.

Evaluation involves a comprehensive history, physical exams, and tests for both partners to identify causes like ovulatory dysfunction, tubal disease, or sperm issues, which are found in 85% of cases. Common tests include semen analysis, hormonal blood tests, ultrasound, and a hysterosalpingogram (HSG). 

Initial Diagnosic Steps

  • Medical & Sexual History: Discussion of cycle regularity, past pregnancies, infections, and lifestyle factors (e.g., smoking, BMI).
  • Blood and Urine tests for infection, including STD’s
  • Physical Exam: A pelvic exam for women and a genital exam for men. 

Female Infertility Tests

  • Ovulation Assessment: Blood tests for progesterone, TSH, and prolactin; ovulation predictor kits.
  • Ovarian Reserve Testing: AMH blood test, Day 3 FSH & Estradiol blood tests and Antral Follicle Count via transvaginal ultrasound.
  • Uterine & Tubal Evaluation:
    • Hysterosalpingogram (HSG): X-ray with dye to check if fallopian tubes are open and to view the uterus.
    • Sonohysterogram (SHG) / Saline Infusion Sonangram: Ultrasound using saline to view the uterus.
    • Hysteroscopy: Direct visualization of the uterus
    • Laparoscopy: A surgical procedure used to diagnose and treat conditions like endometriosiss severe adhesions. 

Male Fertility Tests

  • Semen Analysis: Evaluates sperm count, motility (movement), and morphology (shape).
  • Hormone Testing: Blood tests to check testosterone, FSH, and LH levels.
  • Scrotal Ultrasound: To check for structural issues, such as a varicocele. 

When to Seek Evaluation

  • Under 35: After 1 year of trying.
  • Age 35–39: After 6 months of trying.
  • 40 or older: Immediate evaluation.
  • Known Issues: Women with irregular periods, endometriosis, or a history of pelvic inflammatory disease should seek care sooner. 

About 15-30% of couples may receive a diagnosis of Unexplained Infertility, meaning standard tests did not reveal a specific cause.

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