Clinical inquiries. What is the best way to evaluate secondary infertility?

The work-up for secondary infertility—the inability to conceive after 1 year of regular unprotected intercourse for a couple who have previously had a child1—should include a history and physical exam for both patients, plus evaluation of ovulation, semen analysis, and imaging of the uterus and fallopian tubes (strength of recommendation [sor]: B, based on cohort studies). Check the male partner for varicoceles: they are the leading cause of male secondary infertility. For the female partner, a hysterosalpingogram is an effective first test in the initial evaluation of the uterine cavity and tubal patency (sor: B, based on cohort studies). laparoscopy is indicated where there is evidence or strong suspicion of endometriosis, adhesions, or significant tubal disease (sor: B, cohort studies). routine postcoital testing is unnecessary (sor: A, randomized controlled trial and cohort studies).