Infertility Workup

The workup begins with a decision about urgency, not with a stack of laboratory requisitions. Infertility includes failure to achieve pregnancy after regular unprotected intercourse and the need for medical intervention to achieve pregnancy as an individual or with a partner, regardless of relationship status or sexual orientation. For patients attempting pregnancy through intercourse, begin evaluation after 12 months when the patient with ovaries is younger than 35, and after 6 months when that patient is 35 or older. In a patient over 40, immediate evaluation and treatment may be warranted. Do not wait for the time threshold when there is oligo- or amenorrhea, known or suspected tubal disease or endometriosis, prior pelvic infection, previous chemotherapy or pelvic radiation, or a known risk for male-factor infertility. Assess both partners concurrently. Male factor contributes to approximately half of infertility cases, so semen analysis belongs near the beginning of the pathway rather than after an extensive female-factor workup. The clinical questions are whether ovulation is occurring, whether sperm production and delivery are adequate, whether the tubes are patent, whether the uterine cavity...