Fertility Testing

Fertility is the ability to conceive and produce a child. Pregnancy begins with the fertilization of an egg by a sperm cell, but there are several steps that male and female bodies must go through for a healthy pregnancy to be possible. Some of the steps include:

1. Hormones trigger an ovary to release one egg in a process called ovulation.
2. A partner must produce viable and sufficient sperm.
3. As the egg travels through a fallopian tube to the uterus, it must encounter a sperm cell to be fertilized.
4. The fertilized egg must then get implanted in the lining of the uterus, where it can grow and develop during pregnancy.

If an egg is not fertilized in that cycle, the body sheds the egg and the lining of the uterus during menstruation.

What is infertility?

Infertility is a term that describes an inability to reproduce by natural means. It is defined as not getting pregnant after one year of sex without contraception. Infertility is often due to a problem with one or more steps in the process of becoming pregnant.

Infertility is diagnosed after a couple has tried to get pregnant for 12 months without success, or after 6 months if the woman is over age 35.

Infertility affects around 9% of men and 11% of women of reproductive age in the United States. Although a couple’s infertility can sometimes be traced back to one partner, in around one-third of couples, both partners are responsible for the infertility. In 10-20% of infertile couples, no specific cause can be found.

Fertility testing can be used to detect ovulation and/or to diagnose infertility.

Detecting ovulation

Some types of fertility testing can help women know when they’re most fertile and plan for a pregnancy. A woman is most likely to get pregnant if she has sex during a window starting five days before ovulation to around 24 hours after. This is sometimes referred to as the fertile period.

There are many methods of tracking ovulation and the menstrual cycle. Ovulation tracking can help women who are trying to become pregnant and may help some women who wish to avoid becoming pregnant. Ovulation tracking as a form of birth control is called fertility-based awareness. For most women, fertility-based awareness is around 75% effective.

Diagnosing infertility

Fertility testing can also help doctors diagnose the causes of infertility in a couple. Tests used to diagnose the causes of infertility include laboratory, imaging, and other tests that provide information about a couple’s reproductive organs and the process of becoming pregnant.

Who should get testing?

Couples who are experiencing infertility or who have underlying medical issues should speak to their physician to find out if they should get tested and which tests are indicated for their unique situation.

Fertility testing can help a couple plan for pregnancy, whether the goal is to become pregnant or to avoid pregnancy.

In addition to those already experiencing infertility, there are some risk factors to identify that may affect a couple’s fertility. An infertility evaluation may be important when the couple meets one or several of the following risk factors:

• Women over age 40
• Irregular or absent menstrual periods
• Family history of early menopause or premature ovarian failure
• History of ovarian surgery
• Advanced stage endometriosis
• Uterine or tubal disease
• Exposure to cytotoxic drugs or pelvic radiation therapy
• Autoimmune disease
• Smoking
• Adult mumps
• History of testicular trauma
• Impotence or other sexual dysfunction
• A history of fertility issues with another partner

In women between 35 and 40 years of age without a risk factor, an infertility evaluation may be recommended after attempting to conceive for six months.

In younger couples without risk factors for infertility, experts recommend trying to conceive for a year before having an infertility evaluation. Couples in this category may benefit from tracking fertility and timing intercourse with ovulation. A physician or reproductive endocrinologist can assist couples in creating a tailored plan for fertility testing.

Getting test results

When a fertility test is prescribed by a doctor, results may be discussed during a follow-up appointment or by telephone. At that time, you will typically have an opportunity to ask questions and make sure that you understand your test results and any follow-up testing that may be necessary. Understanding the results of fertility testing can be complex, and decision-making may depend on results of more than one test.

For at-home fertility testing, results may be available immediately, over the phone, or through a website or smartphone app. When using at-home fertility testing, it’s important to discuss results with your doctor to understand what they mean for your fertility.

Fertility tests can help track ovulation to aid couples in identifying the fertile period. There are several tests used to estimate when ovulation occurs:

Infertility is evaluated differently in men than in women. In order to evaluate the causes of female infertility, doctors begin by understanding a woman’s health history and performing a physical examination. Because problems with ovulation are a common cause of infertility, diagnostic tests may be recommended to ensure ovulation is occuring. There are several tests used to help doctors detect problems with ovulation:

• Menstrual cycle charting: Tracking menstrual cycles can help doctors determine the likelihood that ovulation is occurring. Menstrual cycles that last between 25 and 35 days usually indicate healthy ovulation, while longer or shorter cycles may suggest that ovulation is not occurring correctly.

• Basal body temperature monitoring: After ovulation, progesterone is released by the body causing an increase in body temperature. During basal body temperature monitoring, a woman takes her temperature every morning before getting out of bed.

• Progesterone testing: Progesterone testing measures the concentration of progesterone in a blood sample and can help doctors determine if it is likely that ovulation is occurring.

An infertility evaluation may also involve testing a woman’s ovarian reserve, which refers to the quantity and quality of egg cells in the ovaries. Several tests may be performed to assess a woman’s ovarian reserve:

Doctors may order additional testing to diagnose or rule out an issue with ovulation function in women:

An infertility evaluation may also involve imaging tests to assess women for health conditions related to the fallopian tubes and/or uterus and chromosome analysis to look for chromosome abnormalities that can cause infertility.

In men, an infertility evaluation begins with understanding a man’s health history and conducting a physical examination and multiple semen analyses. Also called a sperm count, a semen analysis measures the quality and quantity of sperm in a man’s semen. Semen samples are collected for analysis after two to seven days without ejaculating.

After a semen analysis, a doctor may recommend endocrine testing that can detect conditions that cause male infertility. Endocrine testing may involve several tests:

Other laboratory tests may be ordered as needed to assess whether other conditions may be affecting fertility. In addition to laboratory testing, doctors may suggest ultrasounds of the scrotum and rectum can help doctors diagnose an obstruction in the ejaculatory duct, the pair of tubes through which semen is ejaculated into the urethra.

Genetic testing can determine potential genetic causes of infertility in men. Several types of genetic tests may be used, depending on the situation:

These resources provide additional information about infertility and reproductive health:

• Merck Manual: Overview of Infertility
• National Library of Medicine: Infertility
• Women’sHealth.gov: Infertility
• NIH: Infertility and Fertility
• American College of Obstetricians and Gynecologists: Evaluating Infertility

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