Comprehensive Evaluation

A comprehensive evaluation is a full search for the reasons a couple is not conceiving or has repeated pregnancy losses. It includes both partners. The goal is to identify the root cause rather than simply label the problem. Clinicians select tests based on each couple's history, so the exact workup varies. A common starting point is cycle charting with a method such as the Creighton Model. Hormone blood tests are often timed to specific days after ovulation, when the levels are most informative. Ultrasound scans can track the growth and release of the egg. A sonohysterogram, an ultrasound with saline, examines the inside of the uterus. A hysterosalpingogram (HSG), an X-ray test with dye, checks whether the fallopian tubes are open. For the male partner, a semen analysis measures sperm count, motility (movement) and morphology (shape). Some clinicians also test sperm for DNA damage. Other tests may assess hormonal, immune, clotting or genetic factors. When needed, a small camera gives a direct view inside the body. In laparoscopy, the camera enters through a small incision in the abdomen. In hysteroscopy, it passes through the cervix into the uterus. These procedures can confirm endometriosis, scar tissue, chronic endometritis (persistent inflammation of the uterine lining), or an isthmocele, a defect in a cesarean scar.¹