Primary Investigations:

For the male:

a) Hormonal Profile.

• • FSH, LH
  • Prolactin
  • Free testosterone.

b) Semen Analysis.

This is one of the basic investigations that should be requested as a first step.

Preparation for the semen analysis:

• • The man should abstain from ejaculation for 4-5 days before the test.
  • The sample is produced by masturbation (lubricants and creams should be avoided as they may affect results).
  • The sample should reach the lab within maximum 40 minutes from production and should be preserved at room temperature.
  • The use of condoms is not allowed as they are surrounded by a layer of cream or lubricants which kill the sperm.
  • The semen goes through several stages. It is checked immediately after the production and again after centrifuging and washing it (to get rid of the debris and bacteria). Followed ups occur for its validity and motility for 48 hours to give an accurate assessment for the semen.

The WHO criteria for normal semen is as follows:

• • Number: more than 20,000,000/ml
  • Motility: more than 60 %
  • Progression: more than 2.5/4
  • Abnormal forms: less than 45%

c) Testicular biopsies.

This is either done by small incisions or aspirates.

For the female:

a) Hormonal Profile.

• • FSH, LH (2 – 5 day of the period)
  • Prolactin
  • E2
  • Progesterone (day 21 of the period)
  • Free testosterone.
  • Anti-Molerian hormone (AMH)
  • Free T3, T4 & TSH

b) Ultrasound examination (Trans-vaginal & abdominal)

Using a trans-vaginal probe is more accurate and preferred over using an abdominal probe in assessment of the uterus and ovaries. It can be done during any stage of the menstrual cycle; however it is preferable immediately after menstruation.