Once a couple presents an infertility problem, an organized cost
considerate rapid evaluation that makes no major assumptions about
cause should be recommended.
Assumptions are common, but should be discouraged. When the couple
first identifies an infertility problem there often is a tendency
to guess at the cause for the problem. I often hear: "(s)he
is the problem," "it must be me since my spouse has
had children in another marriage," or "I know I'm normal
since I've never been sick a day in my life." Assumptions
are usually counterproductive.
The basic infertility evaluation should always include an evaluation
* (1) ovulation,
* (2) sperm, and
* (3) the pelvic factor
In addition, it is usually adviseable to confirm that there are
no other major barriers to fertility. This might include looking
at the periovulatory cervical mucus for the presence of progressively
motile sperm several hours following intercourse (postcoital test).
This might also include examining the pelvis for the presence
of abnormalities, such as endometriosis or adhesions (laparoscopy
and possibly hysteroscopy).
If the couple has experienced multiple consecutive miscarriages,
the evaluation that I recommend includes
* (1) demonstration of a normally shaped uterine cavity,
* (2) evaluation for a hormonal deficiency in progesterone
* (3) analysis of both the maternal (wife's) and paternal
* (4) laboratory testing for immunologic causes of pregnancy
* (5) taking a history for maternal disease states or environmental
The components of the basic infetility evaluation are discussed
in detail. The components of the basic recurrent pregnancy loss
evaluation will be the subject of another project (currently in