The diagnostic approach depends on whether the investigation involves a first visit to the doctor, a referral from a gynecologist, an andrologist, urologist, endocrinologist, possible previous infertility treatment (eg ovarian stimulation, insemination, fallopian tube surgery), and previous IVF.
The infertile couple should be investigated together as a unit. In the first visit it is necessary both of them be present, according to international practice. Family and individual history, obstetric history (births, abortions, abortions, etc.), gynecological, surgical history (previous surgeries), age, weight, height, work, smoking, alcohol consumption, possible medication and previous tests (eg, semen analysis, hormone tests, ultrasound, hysterosalpingography, laparoscopy, hysteroscopy) are evaluated.
The diagnostic evaluation after 12-month infertility includes an assessment of the following parameters:
- Male Factor (sperm analysis: 2 or 3 different tests).
- Check of ovulation and the luteal phase of the cycle (FSH, LH, PRL, E2 on days 2-6 of the cycle, progesterone on day 21 of the cycle, ovarian and endometrial ultrasound scanning).
- Cervical factor: post-coital test.
- Uterine factor (hysterosalpingography, hysteroscopy, ultrasound).
- Salpingoperitoneal factor (hysterosalpingography and laparoscopy).
- Endometriosis or other pathological condition of the genital system (laparoscopy).
- Ovarian reserve (FSH, E2, ovarian volume, follicles in the 3rd day of the cycle).
