A couple comes in for an infertility workup,having attempted to get pregnant for 2 years.The woman,37,has always had irregular menstrual cycles but is otherwise healthy.The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago.The man has had two normal semen analyses,but the sperm seem to be clumped together.What additional test is needed?

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The woman has irregular menstrual cycles.The scenario does not indicate that she has had any testing related to this irregularity.Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.Determination of blood levels of prolactin,FSH,luteinizing hormone (LH),estradiol,progesterone,and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles.A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells)or severe oligospermia (low number of sperm cells).Antisperm antibodies are produced by a man against his own sperm.This is unlikely to be the case here,because the husband has already produced children.Examination for testicular infection should be done before semen analysis.Furthermore,infection affects spermatogenesis.However,the woman's hormone levels would likely be tested first.

A Couple Comes in for an Infertility Workup,having Attempted to Get