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Infertility Assessment
Assessment is advised when pregnancy has not occurred after a year of regular unprotected intercourse; the period is reduced to six months if the woman is over 35. The cause is broadly shared between female, male and combined factors, which is why both partners are assessed.
What is investigated in the woman
- Menstrual pattern and assessment of ovulation
- Ovarian reserve (AMH and antral follicle count on ultrasound)
- Thyroid and prolactin tests
- Ultrasound assessment of the uterus and ovaries
- Demonstration of tubal patency (HSG)
- Hysteroscopic assessment of the cavity where required
In the man
The first step is semen analysis. If the result is abnormal the test is repeated and, where needed, assessed jointly with a urologist.
Common causes
- Ovulation disorders and polycystic ovary syndrome
- Blocked tubes or adhesions
- Endometriosis
- Polyps, fibroids and adhesions within the cavity
- Abnormalities of sperm count or motility
- Age-related decline in ovarian reserve
- In a proportion of couples no cause is found
The treatment pathway
Treatment is stepwise according to the cause: lifestyle and weight management, ovulation induction, intrauterine insemination and, in suitable patients, IVF. Where an obstacle exists within the cavity — a polyp, adhesions or a septum — correcting it first improves the outcome.
At every step, why a test is requested and what is expected from it are explained clearly.