When you suspect fertility issues, you want to get right to the source. Those still trying to conceive after 12 or more consecutive months (six months for those over 35) of unprotected intercourse likely seek out their physician’s help. After a basic physical exam and a thorough medical and sexual history from both partners, your doctor may recommend you begin fertility testing.

Obviously the data gathered from the tests hopefully provides enough information for your physician to come to a diagnosis. Once your doctor arrives at a diagnosis, you’re presented with treatment options for a successful pregnancy. But, your doctor cannot provide treatment until they know just what’s going on with your fertility.

A Tool for Diagnosis

Fertility testing is a diagnostic tool and necessary to determine the best approach for navigating a path to pregnancy. For couples who suspect infertility, the idea itself may be overwhelming but we’re going to break down the purpose of each test. Here we offer guidelines for determining who should seek fertility testing, along with a breakdown of fertility testing doctors use for both men and women.

Who Should Test for Fertility

Obviously if you’re interested in having a child and unsuccessful the “old-fashioned way,” or you are a same-sex couple, you should explore fertility testing. For those with underlying medical conditions known to affect fertility, testing is a way to put your mind at ease. A fertility evaluation is recommended for those meeting any of the criteria below:

• Women over the age of 40
• Women with a family history of early menopause
• Those women with a family history of premature ovarian failure
• Those with irregular or no periods
• Those who’ve had pelvic or ovarian surgery
• Uterine or tubal issues
• Advanced endometriosis
• Radiation therapy in the pelvic region
• Chemotherapy
• Autoimmune disorders
• Men who’ve experienced testicular trauma
• Men who’ve had mumps as an adult
• Impotence
• Sexual dysfunction
• Prior history of infertility (with another partner)

Women between the ages of 35-40 with no risk factor who’ve tried to conceive for six consecutive months may need a fertility evaluation, as well as those under 35 who still haven’t conceived after 12 months.

Fertility Testing for Women

Women’s fertility relies on the release of a viable egg for fertilization. The reproductive system allows the egg to travel to the fallopian tubes where it meets with the sperm, and once fertilized, the egg makes its way into the uterus for implantation. Cells divide and grow and you’re pregnant. Any interruption along the way not related to birth control indicates a fertility issue in women.

After a general physical and gynecological exam, your doctor may order specific fertility tests. The most common tests are:

• Ovulatory Testing: In 25% of cases of infertility, ovulatory disorders are the source, according to a 2022 study by the NIH. Your doctor will perform a blood test to check if you’re ovulating normally. The test measures your hormone levels which determines whether or not ovulation is normal.
• Testing Ovarian Reserve: This test measures the quality of eggs available for ovulation. A woman is born with all of the eggs she’ll ever have. Eggs are shed through your monthly period and become non-viable as you age. However, you do retain a store of eggs, or “ovarian reserve,” that have yet to mature. In some cases of ovulatory dysfunction, the ovarian reserve is significantly diminished. Fertility testing early in the menstrual cycle measures your hormones and data confirming your ovarian reserve.
• Additional Hormone Measures for Fertility Testing: Blood tests that check your ovulatory hormones, pituitary hormones and other hormones that control reproduction.
• Hysterosalpingography: This test checks your uterus and fallopian tubes for blockages or other issues, and involves a special x-ray using dye to look at the uterus and fallopian tubes.
• Imaging Tests: Your doctor may do a sonohysterogram (saline infusion sonogram) that uses sound waves and a computer to obtain a more clear view of your uterus.

Depending on the results of your initial fertility testing, your doctor might also include the following tests:

Laparoscopy: A minimally invasive procedure in which your physician examines your ovaries, fallopian tubes and uterus using a small, thin viewing device. This test identifies endometriosis, scarring, irregularities in the fallopian tubes, blockages and issues with your ovaries or uterus.

Hysteroscopy: If your prior test results and symptoms indicate uterine disease or problems with your uterus, your doctor will order a hysteroscopy. For this procedure, your doctor inserts a thin, lighted viewing device through your cervix and into your uterus to assess and evaluate.

Fertility Testing for Men

Men’s fertility depends on the ability of the testicles to produce healthy, sufficient sperm and ejaculate that sperm into the vagina to fertilize the egg. After a general physical, including an assessment of the genitals, the doctor orders specific tests that include:

• Semen Analysis: This includes one or more semen samples and a possible urine sample. You obtain the sample by either masturbating and then collecting the ejaculate in a sample container provided by your physician or by interrupting intercourse at the point of ejaculation, and collecting your sample. The lab analyzes your semen and sperm for viability, and also checks your urine for the presence of sperm, which may indicate an abnormality.
• Test for Hormone Levels: Much like the hormone test for women, a blood test is used to measure levels of testosterone and other hormones.
• Genetic Testing: Sometimes there is a genetic cause of infertility. A chromosome test on a blood sample can help determine if a genetic cause exists.
• Imaging: In some cases your doctor may use imaging to assess your fertility. The tests most commonly used include a vasography that assesses the condition of your vas deferens (the tube that transports sperm to the urethra for ejaculation) and a transrectal or scrotal ultrasound that can uncover disease, scarring and blockages.
• DNA Analysis: The physician is able to detect DNA abnormalities in your sperm using semen analysis.

There are also tests that measure how sperm and egg interact and whether you develop antibodies to the sperm. In certain immune disorders or rare instances, the body detects the sperm as something foreign and attacks and destroys it.

The good news is that it’s unlikely you’ll need all of the tests. Normally, your doctor plots a course of treatment based on the results of just one or two tests.

Let Us Help You

Your goal of growing your family may require fertility testing, which is the best way to find the source of your infertility and act. At Halo Fertility we strive to help you realize your dreams for your family. If you have any questions regarding fertility testing or any other concerns please reach out to Halo Fertility today.