From the Guidelines
Laboratory tests recommended for evaluating infertility include hormonal assessments, genetic testing, and infectious disease screening, with a focus on follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) for women, and semen analysis, testosterone, FSH, and LH for men, as supported by recent guidelines 1.
Key Laboratory Tests for Infertility Evaluation
- For women:
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Estradiol
- Anti-Müllerian hormone (AMH)
- Thyroid-stimulating hormone (TSH)
- Prolactin
- Progesterone level on day 21 of the menstrual cycle
- For men:
- Semen analysis to evaluate sperm count, motility, and morphology
- Blood tests for testosterone, FSH, and LH to assess testicular function
Additional Recommendations
- Both partners should undergo screening for sexually transmitted infections including chlamydia, gonorrhea, and HIV, as these can affect fertility 1.
- Genetic testing such as karyotyping may be recommended in cases of recurrent pregnancy loss or severe male factor infertility, with specific criteria outlined for genetic screening of infertile men 1.
- A physical examination (PE) performed by an examiner with appropriate training and expertise is recommended as part of the initial evaluation for male factor infertility, along with a reproductive history and semen analyses 1.
Prioritization of Tests
The selection of laboratory tests should prioritize those that provide the most relevant information for guiding treatment strategies, with a focus on the most recent and highest quality evidence available 1.
From the Research
Laboratory Tests for Infertility Evaluation
The following laboratory tests are recommended for evaluating infertility:
- Semen analysis: This is the cornerstone of the evaluation of male infertility 2
- Serum progesterone level measurement: To document ovulation in women 3, 4
- Serum basal follicle-stimulating hormone level: To evaluate ovulatory function in women 4
- Clomiphene citrate challenge: To evaluate ovulatory function in women 4
- Hormone assays: To diagnose endocrinopathies, such as hyperprolactinaemia, and to distinguish primary gonadal failure from lesions of the hypothalamic-pituitary axis 5
- Hysterosalpingography: To evaluate the uterus and fallopian tubes in women with no risk of obstruction 3, 6
- Hysteroscopy or laparoscopy: To evaluate the uterus and fallopian tubes in women with a history of endometriosis, pelvic infections, or ectopic pregnancy 3, 6
- Ultrasonic scanning: To monitor follicular growth and evaluate ovarian function 5
- Sperm-cervical mucus tests, hemizona assays, and the sperm-penetration assay: To evaluate functional aspects of male infertility 2
Specialized Tests
In some cases, specialized tests may be necessary, such as:
- MRI: To evaluate the uterus and fallopian tubes in women with a history of endometriosis or pelvic infections 6
- Selective fallopian tube catheterization: To evaluate tubal patency and function 6
- Gonadotropin therapy: To treat abnormalities of sperm in men 3
- Intrauterine insemination or in vitro fertilization: To treat unexplained infertility or male factor infertility 3, 4