- Overview (jump to section): Infertility testing determines the cause(s) of infertility, guiding diagnosis & treatment decisions.
- For women: Testing may involve discussion of medical history, blood tests and other minimally invasive procedures.
- For men: Infertility testing primarily involves a semen analysis and a discussion of health history, and may also include urine, blood or other imaging tests.
What is infertility testing?
Infertility tests are an essential part of getting treatment and very common for anyone experiencing difficulty conceiving. Infertility tests for women and men can include:
- Physical exams.
- Ultrasounds or X-rays.
- Analysis of blood, urine and hormones.
- Ovarian reserve tests for women.
- Semen analysis tests for men.
The underlying causes of infertility can be male factors, female factors, both or unexplained infertility, meaning we can’t pinpoint the exact cause. Evaluating test results provides a fertility specialist a holistic look at where complications exist and what treatments would work best against infertility.
Getting tested for infertility can be emotional and a sensitive topic for some patients. Our providers take care to explain all the testing steps and discuss results to help patients understand possible paths forward. Every patient is unique with an individual journey to parenthood that may involve simpler treatments or more complex assisted reproductive technologies.
When should someone consider getting tested for infertility?
- Women under the age of 35 who have been trying to conceive for a year (or age 35 or older and have been trying for six months).
- Men experiencing infertility, defined as the inability to get a woman pregnant after more than one year of actively trying. There are usually no symptoms, so testing is required to diagnose the cause of infertility.
- If a couple is not conceiving, both the male and female should be tested.
- There are benefits to getting tested earlier rather than later for people who suspect they are having trouble conceiving, particularly those with family history of infertility or other concerns, such as irregular menstrual cycles, pelvic pain, history of pelvic or testicular surgery.
- By testing now, they can uncover potential problems that may prevent pregnancy before these issues become worse from being left untreated.
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Infertility testing for women
Fertility tests for women help identify the cause(s) of infertility so the condition can be properly treated and the couple or individual can have the best chance to conceive.
Testing for women often involves a combination of the specific evaluations below.
A physical exam
A fertility specialist will perform a pelvic and gynecological exam, as well as a medical history discussion. Learning about the patient’s history is an essential part of diagnosing the cause of infertility and determining if further testing should be conducted.
Ultrasound is also used to check the shape of the uterus and the thickness of the uterine lining. An antral follicle count, or AFC, which helps predict the number of eggs available in a woman’s ovaries, may also be done at this time. The number of follicles growing on the surface of a woman’s ovaries can indicate how many eggs would likely be retrieved if the ovaries were stimulated during a fertility treatment, like in vitro fertilization (IVF).
Anti-Müllerian hormone (AMH) levels
A fertility specialist can also run the AMH test to determine ovarian reserve. This is a blood test measuring levels of the anti-Müllerian hormone in the body. As AMH is a hormone secreted by the ovarian follicles, a higher AMH generally means the ovaries have a larger reserve of eggs.
While AMH levels can’t show if patients have a condition that might make it harder to conceive or how quickly their egg count is decreasing, it does provide a good indication of egg count. This can help a fertility specialist determine if a patient is a good candidate for using her own eggs in fertility treatment, or fertility preservation treatment.
Follicle-stimulating hormone (FSH) released from the brain stimulates the follicles on a woman’s ovaries to produce a mature egg from the ovarian follicles. As ovarian function slows down with age or because of other health issues, more FSH needs to be released. An elevated FSH level may indicate that a woman’s ovaries are no longer producing mature eggs that can be fertilized.
Other hormonal infertility testing
A woman’s ability to conceive is determined in large part by the hormonal balances in her body. If hormones are not secreted in the right proportions, a woman’s reproduction process can be affected. A blood test can evaluate hormonal balances.
Other imaging tests like sonohysterogram and hysterosalpingogram
HSG, or hysterosalpingogram, is an X-ray procedure to check that the fallopian tubes are open and not blocked. It also can help a doctor evaluate the shape of the uterus and determine if any growths, such as fibroids, may affect conception.
Hysteroscopy involves placing a telescope-like camera through the cervix into the uterus to take a closer look at the inside of the uterus. This is done if an HSG exam showed potential abnormalities or was inconclusive. Our doctor may also do an endometrial biopsy during this exam.
Sonohysterogram involves placing sterile liquid inside the uterus via a catheter, and then evaluating the uterus and uterine walls via ultrasound.
Diagnostic laparoscopy may be the most invasive of the fertility tests involving minimally invasive surgery with small incisions and viewing instruments. It is usually done when symptoms point to possible endometriosis, as part of treatment for blocked fallopian tubes, or in some cases of unexplained infertility.
Male infertility testing
Male infertility is a condition in which a man’s sperm are not able to reach or fertilize a woman’s egg during or after sexual intercourse. There are many reasons for male infertility, and fertility issues can be just as common in men as women. According to the National Institutes of Health, male factor infertility is the sole cause in a third of all fertility issues and contributes to another third of cases.
For this reason, a semen analysis is typically the first step in assessing a man’s fertility.
A comprehensive semen analysis is one of the primary and often most important male infertility tests. This can determine problems in the sperm’s ability to fertilize a woman’s egg.
Typically, the sample is gathered via masturbation in the clinic. If collected at home, the sample must be delivered to a clinic within 60 minutes to maintain the proper temperature. The sample can also be collected during intercourse by using a special type of condom (provided by our office). Since sperm samples can vary daily, multiple samples may be requested if abnormalities are noted in the first.
We are the only clinic on the North Shore to perform in-house semen analysis.
Prior to providing a sample, men should avoid ejaculating for two to five days to ensure sperm count is at its highest. However, they need not avoid sexual activity beyond this as it could result in less active sperm. In the days leading up to a test, men should also avoid:
- Excessive caffeine.
- Excessive heat to the scrotum (such as in hot tubs or saunas).
Semen analysis results may also suggest additional testing, depending on a man’s personal health history.
What is a fertility doctor analyzing in a semen sample?
- Sperm count: A low sperm count may be the result of numerous factors, but it ultimately accounts for a large percentage of male infertility cases. If a semen sample contains under 15 million sperm cells per milliliter, the sperm count is considered low.
- Sperm motility (what percentage are moving correctly): In order for sperm to fertilize an egg, they must be able to move forward (“swim”) in a normal, efficient manner to get to the egg. Motility measures how many sperm have effective forward motion. Generally, 40% or more sperm should have normal motility.
- Sperm morphology (what percentage are normally shaped): Morphology refers to the shape of a cell or organism. Even in healthy, fertile men, most sperm have abnormally shaped heads or tails. This makes them unsuitable for fertilization. Ideal numbers for normally shaped sperm range from 15%-30%, but numbers as low as 4% can still indicate a good chance of fertilization, if all other factors are positive.
- Volume: The amount of semen per sample can indicate the presence of other problems. For example, abnormally low semen volume (below 1.5 milliliters) may indicate blockage, whereas high volume may be a result of inflammation.
Other male infertility tests
Physical exam and health history
A physical exam is often the best first step. It helps the doctor identify potential problems, and can be used as a stepping stone for additional testing methods.
By checking for visible abnormalities and having a frank discussion with the man about his medical history and lifestyle habits, our doctor can begin to theorize possible reasons for infertility and order additional tests.
Further, one of the most common reasons for male infertility, and one that can be identified through an exam, is the presence of a varicocele. A varicocele is an enlargement of the veins that circulate blood from the testicles and regulate their temperature. If these veins are impeded in their function, infertility can arise from abnormally high testicular temperature. If our doctor suspects a varicocele(s) is leading to issues, he or she will order an MRI, X-ray or ultrasound to more accurately detect it.
A doctor may also order a urinalysis, or a test of a man’s urine. For example, if a semen analysis shows a high white blood cell count, a urinalysis may follow to test for additional white blood cells and antibodies.
If these results are abnormally high, it could indicate an infection or inflammation. If sperm cells are present within the urine, it could point to retrograde ejaculation. This is a condition in which semen travels backward upon ejaculation toward the bladder. A post ejaculatory urinalysis tests for the presence of sperm in a man’s urine.
If the sperm concentration is very low in a semen analysis, it may indicate a genetic cause for infertility. This can be confirmed through genetic testing of the blood samples looking for specific Y chromosome issues in the male partner.
Male hormones, including testosterone, are vital for sperm production and sexual development, so a blood test is commonly conducted to examine hormone levels.
An ultrasound of the man’s scrotum tests for testicle obstruction. A transrectal ultrasound closely looks at the vesicles and ejaculatory ducts that transfer semen.
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- Short wait time for new patient consults.