Fertility Testing

If you are wondering why you've been unable to get pregnant after trying for several months, you may be looking into fertility testing. Difficulty becoming pregnant does not mean you are infertile. A fertility test will help your doctor determine the underlying cause of your challenges to getting pregnant. Your ob-gyn may start the initial evaluation for fertility, however, they may refer you to a reproductive endocrinologist who is a specialist in fertility treatment.

Types of fertility tests

Fertility testing typically focuses on ovarian function, structural abnormalities, and ovarian reserves.

Your menstrual history provides information about your ovarian function. Your doctor will ask questions about your menstrual flow, the regularity of your cycle, and symptoms of breast tenderness, fatigue, and bloating to assess ovulation.

You can use an at-home luteinizing hormone (LH) predictor kit to identify a mid-cycle rise in LH levels. The surge in LH is indicative of ovulation. According to the National Library of Medicine (NLM), measurement of the levels of hormones like progesterone a week before your menses may provide evidence of ovulation and ovarian function.

Ovarian reserves refer to the capacity of the ovaries to produce eggs that can become fertilized. Women with low ovarian reserves may have regular menses but a diminished response to ovarian stimulation, notes the National Library of Medicine.

Your doctor may perform bloodwork and an ultrasound of the ovaries to assess your ovarian reserve. According to the American Society of Reproductive Medicine, several measurements of hormones, including the basal follicle-stimulating hormone (FSH) and estradiol, and antimullerian hormone, provide information about the ovarian reserve. Your doctor will likely obtain a baseline level of your FSH and estradiol between the second and fourth days of your menstrual cycle.

According to the American Society of Reproductive Medicine, structural abnormalities like blocked tubes, pelvic abnormalities, cervical disorders, and uterine abnormalities affect infertility. Your doctor may need to make an assessment:

A cervical examination may be done to identify the narrowing of the passage or chronic inflammation of the cervix.

Uterine abnormalities, including polyps, fibroids, and adhesions can also cause fertility complications. According to the American Society of Reproductive Medicine, ultrasound is the best test for identifying abnormalities in the uterus. Your doctor may use an instrument called hysteroscope to evaluate the uterine cavity and remove lesions. A saline infusion sonogram (SIS) is a less invasive way to view uterine abnormalities.

Tubal disease can cause a blockage in your fallopian tubes. Your doctor may perform an imaging study called hysterosalpingography to evaluate the patency of your tubes.

Other factors that cause fertility complications include pelvic or adnexal adhesions and endometriosis. According to the NLM, a laparoscopy is done when there is suspected endometriosis, pelvic adhesions, or disorders within the pelvis. Your doctor may perform a transvaginal ultrasound to assess for endometriosis and laparoscopy to visually pelvic abnormalities that impair infertility.

When should I consider fertility testing?

The American College of Obstetricians and Gynecologists recommends fertility testing for anyone who is at risk for infertility, with expedited fertility tests for women above 35 years.

Risks for fertility complications, according to the American College of Obstetricians and Gynecologists include:

• Age (women are most fertile in their 20s and early 30s)
• Conditions that are known to cause infertility, such as pelvic inflammatory disease or STDs
• Inconsistent, irregular, or absent periods
• Suspected or known tubal, uterine, or peritoneal disease
• Stage III or IV endometriosis (a disorder with endometrial tissue outside of the uterus)

Your response to donor insemination can be an indication of the need for a fertility test. If you are younger than 35 and fail to get pregnant within 12 months of therapeutic donor insemination or older than 35 and fail to get pregnant within 6 months, you may need fertility testing, according to the American College of Obstetricians and Gynecologists.

What to expect with fertility testing

During your initial appointment with the reproductive endocrinologist, you can usually expect them to obtain a thorough reproductive, medical, and family history and conduct a physical examination.

You can expect your doctor to ask about the amount of time you have been trying to conceive, your menstrual history, obstetrical history, timing and frequency of sexual intercourse, as well as your social history. Your doctor will inquire about STDs (past or present), smoking, alcohol consumption, exercise, occupation, diet, and illicit drug use.

According to the NLM,acute and chronic infections in the abdomen and pelvis can lead to tubal/pelvic adhesions. These adhesions account for a significant amount of infertility. You can expect your doctor to ask about a history of sexually transmitted diseases (STDs). According to the American Society for Reproductive Medicine, the initial visit is an appropriate time to provide prepregnancy counseling and screen for applicable genetic conditions.

The NLM notes that you can expect the healthcare provider to take your vital signs and measure your body mass index (BMI). Your doctor will also typically evaluate your thyroid, examine your breasts for milky discharge, and examine your skin and genitalia for signs of androgen excess.

The physical examination will include an evaluation of the vagina and cervix for abnormalities, pelvic tenderness or masses, and an enlarged or irregular uterus. According to the NLM, a bedside transvaginal ultrasound may be done during the initial visit.

How can I tell if I am infertile

According to Planned Parenthood, infertility may be difficult to identify. The only signs that suggest infertility are difficulty getting pregnant or keeping a pregnancy. The definite way to determine if you have infertility is to consult a doctor and have a fertility test done.

How to get a fertility test

You can get a fertility test from your ob-gyn. However, your ob-gyn provider may refer you to a reproductive endocrinologist—a specialist with expertise and training in reproduction, for the evaluation and treatment of infertility.

Can I get a fertility test at home?

Yes, there are several at-home fertility tests available that can provide an indication of a person's fertility status. However, it's important to note that at-home fertility tests may not be as accurate as tests conducted by a healthcare provider, and they may not be able to identify all potential causes of infertility.

Here are some examples of at-home fertility tests:

• Ovulation predictor kits (OPKs): These tests use urine samples to detect luteinizing hormone (LH), which surges just before ovulation. OPKs can help predict when ovulation is likely to occur, which can be helpful for couples trying to conceive.
• Sperm count tests: These tests use semen samples to measure the concentration and motility of sperm. Some examples of at-home sperm count tests include SpermCheck and YO Home Sperm Test.
• Fertility hormone tests: Some companies offer at-home tests that measure levels of fertility hormones such as follicle-stimulating hormone (FSH) and estradiol. These tests can provide an indication of a woman's ovarian reserve, or how many eggs she has left.

It's important to note that at-home fertility tests should not be used as a substitute for medical advice or diagnosis. If you're concerned about your fertility, it's best to talk to a healthcare provider who can provide a thorough evaluation and recommend appropriate testing.

Cost of fertility testing

The cost of fertility testing depends on the type of test, as well as your location, and insurance coverage. The cost of fertility testing can involve a wide variety of testing, including blood testing, ultrasounds, and physical exams. According to CostHelper.com, the average cost of fertility testing in the US ranges widely from around $20 for an at-home ovulation test kit to several thousand dollars for in-depth and invasive medical testing.

More about infertility

What causes infertility

Infertility can be caused by a variety of factors, both in men and women. Here are some of the most common causes of infertility, as outlined by the Mayo Clinic:

• In women, infertility can be caused by problems with ovulation, blocked or damaged fallopian tubes, endometriosis, uterine abnormalities, or age-related decline in fertility. PCOS, or polycystic ovary syndrome, is also a common cause of infertility in women.
• In men, infertility can be caused by low sperm count or poor sperm motility or morphology, problems with ejaculation, or age-related decline in fertility.
• Certain lifestyle factors can also contribute to infertility in both men and women, including smoking, excessive alcohol consumption, drug use, and obesity.
• Certain medical conditions can affect fertility, such as thyroid disorders, autoimmune disorders, and sexually transmitted infections.
• Some genetic factors can affect fertility, including chromosomal abnormalities, genetic mutations, and inherited conditions such as cystic fibrosis.

How is infertility treated?

The treatment for infertility depends on the underlying cause and can vary widely from person to person. Here are some common treatments for infertility, according to the Mayo Clinic:

• Fertility drugs: For women with ovulation disorders, fertility drugs such as clomiphene citrate, letrozole, and gonadotropins can help stimulate ovulation.
• Intrauterine insemination (IUI): IUI is a procedure in which sperm are placed directly into the uterus around the time of ovulation, to increase the chances of fertilization.
• In vitro fertilization (IVF): IVF is a procedure in which eggs are retrieved from the woman's ovaries and fertilized with sperm in a laboratory, before being transferred back to the uterus.
• Intracytoplasmic sperm injection (ICSI): ICSI is a procedure used in conjunction with IVF, in which a single sperm is injected directly into the egg to aid fertilization.
• Surgery: In some cases, surgery may be required to correct anatomical issues such as blocked fallopian tubes or uterine fibroids.
• Lifestyle changes: In some cases, lifestyle changes such as quitting smoking, reducing alcohol consumption, or losing weight can improve fertility.

It's important to note that not all infertility cases can be treated, and some people may need to explore alternative family-building options such as adoption or surrogacy. If you're experiencing infertility, it's important to talk to a healthcare provider who can provide a thorough evaluation and recommend appropriate treatment options.

What are the signs of infertility?

The signs of infertility can vary depending on the underlying cause and whether it affects a man or a woman. According to the Mayo Clinic, some symptoms of infertility are:

For women:

• Irregular or absent menstrual periods: Irregular or absent periods can be a sign of ovulation disorders, which can affect fertility.
• Painful periods: Painful periods may be a sign of endometriosis, which can cause infertility.
• Abnormal vaginal discharge: Abnormal vaginal discharge may be a sign of a vaginal or cervical infection that can affect fertility.
• Pain during sex: Pain during sex may be a sign of endometriosis or other conditions that can affect fertility.
• Age: Women over the age of 35 may experience an age-related decline in fertility, which can make it more difficult to conceive.

For men:

• Low sperm count: Low sperm count is a common cause of male infertility.
• Poor sperm motility: Poor sperm motility, or the inability of sperm to move properly, can also affect fertility.
• Pain or swelling in the testicles: Pain or swelling in the testicles may be a sign of an underlying medical condition that can affect fertility.
• Erectile dysfunction: Erectile dysfunction can make it difficult for men to conceive.

It's important to note that many people with infertility may not experience any obvious symptoms, and the only way to determine whether infertility is present is through medical testing.

If you're concerned about your fertility, it's best to talk to a healthcare provider who can provide a thorough evaluation and recommend appropriate testing.