Q: What comprises a basic infertility evaluation?
A: While a consensus on what comprises a basic infertility evaluation does not exist; most fertility specialists agree there are three main issues that need evaluation: Semen analysis, ovulation competency and fallopian tube patency.
Semen analysis by World Health Organization (WHO) guidelines gives an analysis of sperm count, percent that are motile or moving and percent that have normal morphology: i.e. normal shape and structural features. More recently the WHO has also stated a strict morphology that identifies the number of “superstar” sperm provides a more accurate assessment and therefore should be measured. Tubal patency is evaluated with and x-ray procedure called a Hysterosalpingogram (HSG). Tubal patency can also be assessed at the time of a Laparoscopy surgery. Ovulation presence and quality is evaluated with basal body temperature charting and mid luteal serum progesterone. Infertility specialists often also do a mid cycle ultrasound to evaluate follicle and endometrial implantation site development. Abnormalities in any of these three areas i.e. semen analysis, tubal patency or ovulation leads to decreased fertility. Other tests including serum antibody testing, endometrial biopsy, and varicocele evaluation have more limited values.
In summary, your doctor should obtain a complete history and physical of both you and your spouse. A cost effective initial infertility evaluation would include: complete semen analysis, HSG and mid luteal progesterone to assess ovulation. Any patient older than 35 or with reason to believe there is a decrease in ovarian reserve should have a day 3 serum FSH test. Further evaluation and treatment can then be tailored by this initial assessment.
See our article in the ”Stepping Stones” Newsletter. Visit the website at www.bethany.org/step.
