Fertility tests are an essential part of fertility evaluation and treatment. Through testing, it may be possible to discover what is preventing a patient and her partner from achieving pregnancy. A regular gynecologist may do some basic testing, but a reproductive endocrinologist (a doctor specializing in fertility) or a urologist (for male infertility) usually performs the more thorough fertility testing.
Fertility testing involves both partners. While we may think of pregnancy as happening in the woman’s body, conception takes two! According to the American Society of Reproductive Medicine, one-third of infertility cases are due to female factor infertility, one-third are due to male factor infertility, and the remaining third are due to problems on both sides or unexplained infertility.
Female Fertility Tests
Not every fertility test will be done for every case. The more invasive fertility tests, like diagnostic laparoscopy, are only done when symptoms or other tests point in that direction, or when a cause for infertility cannot be found otherwise. For women, fertility testing may include blood work.
Blood work may check hormones, including LH, FSH, thyroid hormones, androgen hormones, prolactin, estradiol (E2), and progesterone. AMH, or anti-mullerian hormone, may also be tested for. Some of this blood work must be done on a particular day of the menstrual cycle. For example, FSH is usually checked on day 2, 3 or 4 of the menstrual cycle, and progesterone is usually checked around day 21 (or one week after ovulation) of the cycle. The following procedures are part of the fertility evaluation:
- Ultrasound is used to check the shape of the uterus and the thickness of the uterine lining. An antral follicle count, which predicts the quantity of eggs available in a woman’s ovaries, may also be done via ultrasound.
- HSG, or hysterosalpingogram, is performed to check that the fallopian tubes are open and not blocked, as well as to evaluate the shape of the uterus.
- Endometrial biopsy, which involves taking a small amount of tissue from the uterine lining (or endometrium), may be performed. This test is not commonly done.
- 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.
- Sonohysterogram (SHG) involves placing sterile liquid inside the uterus (via a catheter), and then evaluating the uterus and uterine walls via ultrasound.
- Diagnostic laparoscopy is the most invasive of the fertility tests. This test is only done when symptoms point to possible endometriosis, as part of treatment for blocked fallopian tubes, or in some cases of unexplained infertility.
Male Fertility Tests
Semen analysis is the main fertility test for men. It involves the man providing a semen sample for a lab to evaluate. Ideally, the test should be performed twice, on separate days, to confirm the results.
Usually, only a semen analysis is needed to diagnose male infertility. However, further testing may also be performed, including:
- A general physical exam by a urologist
- Specialized semen analysis, including genetic testing of the sperm (looking for the presence of antibodies) and evaluation of immobile sperm (to see if they are dead or alive)
- Blood work to check hormone levels, usually of FSH and testosterone, but sometimes also LH, estradiol, or prolactin
- Ultrasound, to evaluate the seminal vesicles and scrotum
After Fertility Testing
Once fertility testing is complete, you will meet with Dr. Levi to discuss what the results mean, what treatment would be appropriate, and decide the next step to take.