Infertility

Evaluation of male factors
A. Semen Analysis
-the Semen parameters in normal fertile males may vary significantly over time, and the first response to any abnormal result should be to wait an interval of several weeks to months and repeat the test. Keeping in mind that the cycle of spermatogenesis takes about 74 days. <5 million sperm /ml warrants an endrocrinologic evaluation including FSH, LH, and testosterone, or a karyotype in selected cases.
B. DNA assays
Several tests, including sperm chromatic structure assay (SCSA), comet, and terminal dUTP nick-end labeling (TUNEL) , have been developed to quantify the damage to DNA or chromatin.
C. Other tests: Postcoital test, antibody studies , a sperm penetration assay.

Evaluation of female factors
A. Ovulatory factor
Historical: onset of menarche, cycle length, premenstrual symptoms.
Confirmation of ovulation : history of mittelschmerz and / or regular menses with molimina and mild dysmenorrhea occur at intervals of 28-32 days, the likelihood of the patient having regular ovulatory cycles is very high. Progesterone levels of >3 ng/mL in the third week of the cycle.
Pelvic ultrasonography can provide evidence for ovulation. The disappearance of, or change in, the follicle and free fluid in the cul-de-sac can document ovulation.
B. The pelvic factor
Including abnormalities of the uterus , fallopian tubes, ovaries, and adjacent pelvic structureS. History: PID, appendicitis, intrauterine devices , endometritis, and septic abortion.
C. The cervical factor
Indicated by a history of abnormal pap smears, Postcoital bleeding, cryotherapy, conization, or DES exposure in utero.