The initial workup of the infertile couple consists of a semen analysis, detection of ovulatory function by various methods, and evaluation of tubal patency by hysterosalpingogram (HSG) with concomitant fluoroscopy. Further evaluation of pelvic anatomy, either by laparoscopy and/or hysteroscopy may be considered as a part of the initial workup if there is an abnormality on HSG or later if no cause for infertility can be found.
Purely diagnostic laparoscopy for the infertile woman is being used less frequently as more couples are advanced on the ART earlier in the evaluation. Other procedures such as Y chromosome mapping, anti-sperm antibodies, sperm penetration assay (SPA), or other tests of sperm function may be used in certain cases.
The evaluation consists of a detailed history, physical examination, assessment of ovulation, semen evaluation, as well as uterotubal assessment. In addition, follicle-stimulating hormone (FSH), and estradiol levels obtained on the third day of the menstrual cycle maybe useful in women older than 35.