Diagnostics

Female infertility may manifest with symptoms of anovulation (e.g., amenorrhea, irregular menses).

• Medical history of both partners, especially gynecological history (e.g., children, family history)

• Menstrual history

• Body temperature analysis to monitor menstrual cycle

• Hormone tests

  • Midluteal serum progesterone levels: progesterone should increase shortly after ovulation → failure of progesterone levels to rise indicates anovulation

  • Ovulation prediction test (detect LH levels)

  • Androgen levels: elevated levels induce negative feedback to the hypothalamus → inhibition GnRH secretion → decreased estrogen levels and suppression of ovulation

  • Ovarian reserve

    • Early follicular FSH levels: elevated in ovarian insufficiency and indicate reduced ovarian reserve

    • Early follicular estradiol levels

    • Anti-Müllerian hormone levels

  • TSH levels: elevated levels in hypothyroidism

  • Prolactin levels: hyperprolactinemia

• Ovarian sonography: antral follicle count

• Endometrial biopsy

  • Usually performed 1–3 days before menstruation to determine thickness of endometrium

  • A flat endometrial lining indicates a defect in the luteal phase of the menstrual cycle.

assess the patency of fallopian tubes and uterus

• Indications

  • If the initial workup does not reveal any abnormalities and no history suggestive of tubal obstruction

  • Screen for tubal occlusion and structural uterine abnormalities (e.g., septate uterus, submucous fibroids, intrauterine adhesions)

• Hysterosalpingography: an imaging technique involving the injection of contrast dye into the cervical canal and serial radiographs to evaluate the uterine cavity and morphology/patency of the fallopian tubes

• Sonohysterosalpingography: an ultrasound technique in which fluid is inserted into the uterus via the cervix to examine the uterine lining

• Hysteroscopy and/or laparoscopy

  • Indicated if there is evidence of intrauterine abnormalities or tubal occlusion.

  • Can also be used therapeutically to remove small adhesions or mucous plugs obstructing the tubal lumen

• Physical examination

• Pap smear

• Testing for antisperm antibodies in cervical mucus

• Medical history of both partners

• Semen analysis

• Mixed antiglobulin reaction test for antisperm antibodies

  • Antisperm antibodies form in disruption of the blood-testis barrier (composed of Sertoli cell tight-junctions)

  • The antibodies can lead to immobilization and agglutination of sperm or have a spermatotoxic effect.

• TSH levels

• Prolactin levels

• Karyotype test (Klinefelter syndrome)