who are under age 40. Some instances of female infertility are caused by DNA repair dysregulation during meiosis. Diagnosis Diagnosis of infertility begins with a medical history and physical exam. The healthcare provider may order tests, including the following: Lab tests Hormone testing, to measure levels of female hormones at certain times during a menstrual cycle. Day 2 or 3 measure of FSH and estrogen, to assess ovarian reserve. Measurements of thyroid function (a thyroid stimulating hormone (TSH) level of between 1 and 2 is considered optimal for conception). Measurement of progesterone in the second half of the cycle to help confirm ovulation. Anti-Müllerian hormone to estimate ovarian reserve. Examination and imaging An endometrial biopsy, to verify ovulation and inspect the lining of the uterus. Laparoscopy, which allows the provider to inspect the pelvic organs. Fertiloscopy, a relatively new surgical technique used for early diagnosis (and immediate treatment). Pap smear, to check for signs of infection. Pelvic exam, to look for abnormalities or infection. A postcoital test, which is done soon after intercourse to check for problems with sperm surviving in cervical mucous (not commonly used now because of test unreliability). Hysterosalpingography or sonosalpingography, to check for tube patency Sonohysterography to check for uterine abnormalities. There are genetic testing techniques under development to detect any mutation in genes associated with female infertility. Initial diagnosis and treatment of infertility is usually made by obstetrician/gynecologists or women's health nurse practitioners. If initial treatments are unsuccessful, referral is usually made to physicians who are fellowship trained as reproductive endocrinologists. Reproductive endocrinologists are usually obstetrician/gynecologists with advanced training in reproductive endocrinology and infertility (in North America). These physicians treat reproductive disorders affecting not only women but also men, children, and teens. Usually reproductive endocrinology & infertility medical practices do not see women for general maternity care. The practice is primarily focused on helping their women to conceive and to correct any issues related to recurring pregnancy loss. Definition There is no unanimous definition of female infertility, because the definition depends on social and physical characteristics which may vary by culture and situation. NICE guidelines state that: "A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner." It is recommended that a consultation with a fertility specialist