ABSTRACT
Infertility affects one in six to seven couples, and more couples are seeking help than previously. As in other fields of medicine, management of the patient(s) can only be appropriately provided once the causes(s) of the problem are discovered, which in turn requires a proper history, physical examination and appropriate investigations to be undertaken. Since investigations may be expensive and occasionally invasive, unnecessary testing will only serve to increase the already high (financial and in terms of time commitment) cost to the couple and to the healthcare system. Couples wish to know why they have not been able to conceive and, depending on the etiology, to be provided the most appropriate options available to them for treatment. Critical evaluation of various investigations for infertility was undertaken at a recent workshop of the European Society of Human Reproduction and Embryology (ESHRE).1 The classical criteria used to evaluate the usefulness of any diagnostic test include sensitivity (to minimize false negatives), specificity (to minimize false positives), usefulness (does knowing the result alter the management?), positive and negative predictive values, safety, and cost. The aim of this review is to provide an overview of the approach to the investigation of the infertile couple. Traditionally, infertility investigations are generally begun after a year of involuntary infertility. However, individual circumstances differ, and if there are factors such as increased female age, irregular menstrual cycles, or a history of previous pelvic surgery, earlier investigation may be warranted.
