Laboratory and radiological investigations in infertility

See #srg2-c14-s6-2__tsrg2-c14-tbl2 for a guide to laboratory investigations of infertility that are helpful in general practice.

Radiological investigation can be requested in general practice. Transvaginal ultrasound scan of the ovaries, tubes and uterus is useful for all females with suspected infertility, and should be performed in the first half of the menstrual cycle1. It can estimate the number of follicles as well as abnormal anatomy of the uterus. If PCOS is suspected, specifically request evaluation for an abnormally high follicle count.

Serum anti-Mullerian hormone (AMH) testing in females is not advised, except in a specialist setting. It is an indicator of the number of ovarian follicles remaining but not of the quality of oocytes, so is not a straightforward predictor of fertility. In males, testing of antisperm antibodies is not recommended in general practice, because evidence of their impact on fertility is insufficient.

Note: Testing of serum anti-Mullerian hormone should be reserved for a specialist setting.

Tests of tubal patency (eg hysterosalpingogram, hysteroscopic contrast sonography [HyCoSy], laparoscopy with dye) should be reserved for request by a specialist or a general practitioner with experience in fertility treatments, with imaging performed in centres with specialist interest in these tests.

In males, additional tests that may be considered by specialists include a karyotype, testing for Y chromosome aberrations, haemochromatosis and serum sex hormone–binding globulin concentration.

1 A transvaginal ultrasound scan is preferred because it is gives best detail, including more reliable follicle counts. A transabdominal approach is an alternative if a transvaginal scan is not available or is declined. In amenorrhoea, ultrasound can be undertaken as soon as is convenient and referral to a fertility specialist should not be delayed by waiting for a menstrual period.Return