A systematic diagnostic process for couples who do not achieve pregnancy after one year of unprotected intercourse. It includes joint evaluation of female and male factors.
Indication
- Failure to achieve pregnancy despite regular unprotected intercourse for one year (women under 35)
- Failure to achieve pregnancy after 6 months of unprotected intercourse in women aged 35 and over
- History of irregular menstruation (oligomenorrhea) or absent menstruation (amenorrhea)
- Known history of pelvic infection, endometriosis, fibroids, or surgery
- Recurrent pregnancy loss (2 or more)
- Male history of testicular trauma, varicocele, or chemotherapy
Preparation
- Appointment between days 2-5 of the menstrual cycle for hormone tests
- Sexual abstinence for 3-5 days before semen analysis
- Avoidance of strenuous exercise and stress in the 24 hours before testing
- Presentation of current medications and prior test results to the physician
How it's performed
- The couple's joint history, menstrual pattern, intercourse frequency, and sexual health are evaluated
- Baseline hormone panel in the female (FSH, LH, estradiol, AMH, TSH, prolactin) is performed
- Pelvic ultrasound is used to examine ovarian reserve (antral follicle count) and uterine structure
- Hysterosalpingography (HSG) is planned to assess tubal patency
- Semen analysis evaluates sperm count, motility, and morphology in the male partner
- Additional tests (genetic testing, laparoscopy) may be considered based on the results
Post-procedure
- Discussion of the treatment plan with the couple based on test results
- Evaluation of options such as ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF)
- Lifestyle recommendations (weight, smoking, alcohol, folic acid supplementation)
- Plan revision within 3-6 months if the first treatment attempt is unsuccessful
- Referral to endocrinology or genetic counseling if needed
Risks
- Transient abdominal pain and mild bleeding during HSG
- Rare allergic reaction to contrast material
- Psychological burden caused by a prolonged diagnostic process
- Surgical risks of certain investigations (such as laparoscopy)
- Need for repeat testing if tests are scheduled at the wrong time
FAQ
How long does an infertility evaluation take?
Basic female and male evaluation is generally completed within 1-2 menstrual cycles. Because some tests must be performed on specific days of the cycle, the process may take 4-8 weeks.
Should my partner also come to the appointment?
Yes. In approximately 30-40% of couples the cause is related to the male, and in 20-30% it involves both partners. Therefore the evaluation should be initiated as a couple.
Are the tests painful?
Blood tests and ultrasound are painless. During HSG some women feel cramping similar to menstrual pain; the procedure takes 5-10 minutes and a pain reliever can be taken in advance.
Is a cause always identified?
No. In approximately 10-15% of couples all tests come back normal; this is called unexplained infertility, and effective treatment options are still available.
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