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Where cycles are irregular or the woman has oligomenorrhoea (a cycle length of 35 days) or polymenorrhoea ( 25 days), x Testicular maldescent or orchidopexy x Chemotherapy or radiotherapy x Previous urogenital surgery x History of sexually transmitted disease x Varicocele Before a year Initial investigations that can be done in primary care Female x Luteinising hormone, follicle stimulating hormone (FSH), and estradiol concentrations-should be measured in early follicular phase (days 2 to 6) x Progesterone test-should be done mid-luteal phase (day 21 or seven days before expected menses) x Thyroid stimulating hormone, prolactin, testosterone test-should be done if womans cycle is irregular, shortened, or prolonged or if progesterone indicates anovulation x Rubella serology test-should be checked even if the woman has been immunised in past x Cervical smear-should be carried out as normal screening protocol x Transvaginal ultrasound scan-should be done if there is the possibility of polycystic ovaries or fibroids Male x Semen sample for analysis-sample should be taken after two or three days abstinence and repeated after six weeks if abnormal The female partner of couples presenting with subfertility should have their rubella status checked so that if immunisation is required it will not delay any treatment 15.
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