Semen analysis remains the most commonly performed investigation in the male. To adjust for fluctuations in semen parameters, a minimum of two samples 4 weeks apart should be analysed. Samples should be collected after a period of 2-7 days of abstinence. There is some debate about the predictive value of the routine semen analysis. WHO reference values for semen quality have been based on populations of fertile men and can act as a guide (WHO, 2000). Large laboratories may have their own population-based normal ranges (Table 45.12). The standard semen analysis has a sensitivity of 89.6%, that is, it is able to detect 9 out of 10 men with a genuine problem. It is not, however, a particularly specific test and a single sample analysis will falsely identify 10% of men as abnormal. Repeating the test reduces this chance to 2%.
A normal menstrual cycle is suggestive of ovulation. Confirmation of ovulation is usually obtained by means of a mid-luteal serum progesterone level in excess of 30 nmol/l 7 days before the onset of menstruation (day 21 of a 28 day cycle). In addition to tests of ovulation, a rubella screen should be performed on each woman. There is little evidence that routine use of temperature charts and LH detection kits improves clinical outcome. There is no justification for routine assessment of FSH, LH, prolactin and thyroid function in ovulatory women.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.