Q&A: Gold Standard in Female Infertility Evaluation

Female fertility specialist, Dr. Dan Lebovic answers the question, “Is there a gold standard in female infertility evaluation?”

The gold standard evaluation for female infertility may need to be tailored depending on the patient’s potential cause of infertility but if there is no known issue readily apparent then specific tests are most certainly warranted. The Practice Committee of the American Society for Reproductive Medicine (ASRM) notes that the fertility evaluation of infertile women (2021) ought to be conducted in a systematic, expeditious, and cost-effective manner.  It goes without saying that pertinent history and targeted physical examinations ought to be performed.  In terms of diagnostic testing, if there is doubt on whether ovulation is occurring, a serum progesterone obtained ~1 week before the expected onset of the next menses can provide evidence of recent ovulation.  Transvaginal sonography may reveal the number of antral follicles (small fluid-filled cysts in the ovaries containing immature eggs) at baseline and assess the uterine anatomy.  Hormonal testing for “ovarian reserve” (reproductive potential as a function of the number of oocytes) is measured with a serum antimüllerian hormone (AMH) level at any time in the menstrual cycle.  A hysterosalpingogram with imaging of the inside of the uterus (womb) and assessment of tubal patency is done between cycle days 6 through 12.  Given the relatively high incidence of thyroid abnormalities and negative implications on pregnancy, it is routine to screen for thyroid disease with a thyroid-stimulating hormone (TSH) level.  Other tests may be warranted based on findings from a woman’s history/physical but the aforementioned diagnostic testing is considered the so-called “gold standard” in female infertility evaluation.  In summary, these tests include:

  • Targeted history and physical (as needed)
  • Serum progesterone if ovulation is uncertain
  • TSH
  • AMH
  • HSG