Assessment of the infertile couple - the first approach

Infertility is defined as the absence of pregnancy after 1 year of frequent and unprotected sexual intercourse. However, depending on the clinical situation, the study for evaluation and diagnosis may begin before 12 months:

• as in the case of women over 35 years of age where it makes sense to start the investigation at 6 months,
• or in cases where there is a clinical history of menstrual irregularities (oligomenorrhea and/or amenorrhea), suspected endometriosis, sexual dysfunction or a condition that may affect ovarian reserve (for example, history of chemotherapy or radiotherapy)

The diagnostic evaluation of the infertile couple includes a complete clinical history, including gynecological, obstetric, medical and surgical history, as well as family history.

Regarding diagnostic tests, they will be requested based on the history and clinical findings, but some are always necessary, such as pelvic ultrasound, clinical analysis and sperm analysis. To assess the patency of the fallopian tubes, a hysterosalpingography or hysterosonosalpingography may be requested. In cases where no cause for infertility is found or if there is suspicion of intrauterine pathology, a hysteroscopy may be indicated.

Bibliography:
Obstetrics & Gynecology, ACOG Committee Opinion, Vol 133 nº 6 June 2011
Fertility evaluation of infertile women: a committee opinion. Fertility & Sterility Vol 116, nº5, Nov 2021