Patients often ask what tests are required for infertility. When should I go for the test? These questions should first understand the causes of infertility: infertility is a problem for both men and women, the male party must have normal sperm, the female party must have normal eggs, and after ovulation, the sperm and eggs must combine and enter the uterus smoothly and take root so as to conceive a baby, and any of these problems will lead to infertility. For example: male sperm problems; female vaginitis, cervicitis, pelvic inflammatory disease; poor follicular development, non-ovulation or luteal insufficiency after ovulation (e.g. polycystic ovary syndrome, hyperprolactinemia, unruptured follicular luteinization syndrome, etc.); fallopian tubes that are incompetent or incompetent, elevated or adherent; uterine malformations (e.g. longitudinal uterus, double uterus, bicornuate uterus, unicornuate uterus), uterine cavity adhesions or polyps resulting in inability of fertilized egg to be laid; immune factors, etc. So, what tests should be done at what time when infertility occurs? First, the male side should be examined first: Because the male side examination is easy, painless and non-invasive, it should be the first choice. It is more accurate to check within 3-7 days of intercourse, and to prevent errors, it is better to review the test again if it is still abnormal and then do the treatment. Many people think that infertility is the woman’s problem, and the wife checks over and over, only to find out that it is the husband’s problem. This is a lot of detours, a lot of money, a lot of suffering and not to mention the delay, affecting the feelings of the couple is not worth it. Second, the female side of the examination: to follow the “simple to complex, from non-invasive to invasive” principle step by step. 1, first do gynecological examination: to see if there is vaginitis, cervicitis; uterus position, size, mobility, inflammation; adnexa (fallopian tubes and ovaries collectively called adnexa, that is, the annexes of the uterus) for thickening, pressure pain. The gynecologist’s eyes and hands are very useful to check out the inflammation that cannot be detected by ultrasound. 2, ultrasound examination: two purposes: one is to see the development of the uterus, whether there are deformities and myomas, adenomyosis, endometriosis, ovarian cysts, etc.; the second is to check whether there is ovulation. It is painless and accurate, and the cost is not high, but it is not possible to determine whether ovulation is present in a single examination for life, because it is affected by many factors such as mental tension and irregular life. Ovulation check starts on the 11th-12th day of menstruation, and continuous testing under the guidance of a doctor is required to see the process of follicles from small to large and from maturity to discharge. 3. Blood sampling: Checking endocrine and the presence of antibodies (1) Checking endocrine. There are two times: one is to check the reserve function of the ovaries, whether there is ovarian hypofunction or decline, increased prolactin, polycystic ovary syndrome and other abnormal hormonal manifestations on the 2nd-5th day of menstruation at around 9:00 on an empty stomach; the other time is to check the luteal function on the 7th day after ovulation or the 21st day of menstruation on an empty stomach (especially for early menstrual cycle and biochemical pregnancy, spontaneous abortion, habitual abortion). The other time is to take blood on empty stomach 7 days after ovulation or 21 days after menstruation to check luteal function (especially for early menstrual cycle and biochemical pregnancy, spontaneous abortion, habitual abortion and history of fetal abortion). (2) Checking antibodies (i.e. to see if there is immune infertility): there is no time limit, blood can be drawn on an empty stomach on any day. 4.Checking the fallopian tubes: there are different examination methods such as lavage (also called lavage), imaging, hysteroscopic intubation, laparoscopy, etc. (the common ones are lavage and imaging), and the examination time is within 3-7 days after menstruation. (1) lysis: If you are not pregnant within six months and you are in a hurry, you can do tubal lysis first (because of the simple operation, low cost, and a certain therapeutic effect on mild flux but not smooth), but remember not to think that lysis can open the blocked fallopian tubes and repeatedly go through, which is more likely to be infected, and give bad motives to the hospital and doctors sent to the wrong money. (2) Imaging: Since fluid is not very accurate and can only be seen by the doctor’s feeling but not the specific situation of the fallopian tubes, if you do not get pregnant for more than one year or if there is no problem with other tests mentioned above and you are still not pregnant, you should choose imaging. The imaging can be used for real-time dynamic observation of the tubal patency and peristalsis, the presence of fluid and adhesions, and can be used to take pictures for data preservation, with little pain and high accuracy. 5. Hysteroscopy: Especially for those who have low menstrual flow, heavy menstruation, prolonged menstruation, multiple ovulatory bleeding, irregular vaginal bleeding, ultrasound suggesting thick or thin endometrium, miscarriage or fetal abortion, hysteroscopy must be checked to see if there is endometritis, endometrial polyp, submucosal fibroid, uterine cavity adhesion, uterine malformation, etc. (I had a patient who had three early pregnancies and could not find the cause of the abortions, but the hysteroscopy revealed an incomplete mediastinum, which was removed and she is now 39 weeks pregnant!) . At the same time, it is also possible to do hysteroscopic intubation and fluids, which is more accurate than the general fluids. 6, laparoscopy: If unexplained infertility or tubal imaging reveals blockage of the umbilical end (i.e. distal end), water retention, uplift, adhesions, poor pelvic dispersion of contrast agent, etc., laparoscopy should be done for those with poor results of conservative treatment such as drugs and interventions, only laparoscopy is the “gold standard” for tubal examination. Laparoscopy can directly observe whether there are lesions or adhesions in the uterus, fallopian tubes and ovaries, and can be used at any time to pass fluid under direct vision to see whether the fallopian tubes are open or not, and can also be used at any time for treatment such as separation of adhesions, treatment of hydrocele, tubal plastic surgery, treatment of endometriosis, etc. In about 20% of patients, laparoscopy can reveal lesions that were not clearly diagnosed before surgery. Laparoscopy should also be performed for a history of infertility longer than 3 years. Many studies have reported that laparoscopy in patients with unexplained infertility revealed endometriosis in 1/3 of the patients and tubal disease and pelvic adhesions in 15%-30% of the patients, so laparoscopy is necessary to determine unexplained infertility. Hysteroscopy and laparoscopy examination and treatment are a revolution in modern obstetrics and gynecology, and their use is a boon to infertility patients, bringing unexpected results with advantages such as minimally invasive, short hospitalization days and good curative effect.