Dr. Roger Lobo: Hi! I am Dr. Roger Lobo with the American Society for Reproductive Medicine. Today we are talking about the diagnosis of infertility and the basic infertility evaluation. When a couple does not conceive after one year of unprotected intercourse or after six months when a women is over age 35, or if there are know problems within fertility, we recommend that both partners be evaluated. Dr. Janet Choi: But normal questions that a woman might ask herself are things like, are my menstrual cycles regular? Are they coming basically every month with a little bit of variations here or there, that's totally fine. But if the woman notes, and looks back and says, you know what, I seem to be getting a period once every two to three months or once a year, that could be an indication that maybe she is not ovulating releasing egg every month, which can make it very difficult for that person to conceive. Dr. Roger Lobo: For the women, a board certified Obstetrician-Gynecologist can provide a basic infertility evaluation and treatment. However, many causes of infertility are best treated by a board certified reproductive endocrinologist. If there are sperm abnormalities, men should be referred to an urologist, who specializes in male infertilities. The basic infertility evaluation for a women looks at her ability to produce eggs and the condition and function of her uterus and tubes. A complete medical history and physical examination are important starting points. One of the first areas to check is the woman's menstrual cycle. Is she menstruating regularly and how often? This provides clues about whether she is ovulating. And over-the-counter ovulation kit can also be used to tell if her hormones are stimulating the release of eggs. Ultrasound may also be used to measure the growth of follicles which are the structures in the ovaries containing developing eggs. For women who don't have regular periods, it's important to check hormonal levels. When there is too little estrogen or too much of certain other hormones, ovulation may not occur. A test for ovarian reserve can check the number and quality of eggs remaining in the ovaries, which is important for the potential for pregnancy. Another important diagnostic test is that hysterosalpingogram, often called an HSG. This X-ray procedure is performed to find out if the fallopian tubes are open, and to see if the shape of the uterus is normal. A small tube is inserted through the cervix and dye enters the uterus and flows out through the fallopian tube. Another test similar to the HSG is called a sonohysterogram, which uses ultrasound and a water based solution to image the inside of the uterus. The most basic test for male fertility is the semen analysis. Men are asked to abstain from ejaculating for at least two days, and then collect the semen sample usually by masturbation. Under a microscope, the number, movement and shape of sperm are examined. If the sperm count is low, a repeat sample is requested. When the results of all these tests are in, the couple and their physician can set up a plan for treatment or order additional test if necessary. To learn more check out our other videos on fertility; including treatments for infertility.