Key points of infertility testing

• Fertility testing identifies the cause(s) of infertility, leading to diagnosis & treatment decisions.
• For women, testing may include an analysis of medical history, blood tests to evaluate reproductive hormone levels, follicular ultrasound to identify follicle count, and other procedures such as ovarian reserve testing and hysteroscopy.
• For men, infertility testing generally involves a semen analysis and discussion of health history; testing may also include blood or urine evaluations and other imaging tests.

What is infertility testing?

Infertility tests are necessary for anyone experiencing difficulty conceiving in order to accurately diagnose the cause(s) and begin getting effective treatment. Fertility tests for women and men consist of:

• Discussion of general and reproductive health.
• Physical exams.
• Analysis of blood, urine and hormones.
• Ultrasounds or X-rays.
• Semen analysis tests for men.
• Ovarian reserve tests for women.
• Hysteroscopy and diagnostic laparoscopy for women.

Some of the basic causes of infertility can be male factors, female factors or a combination of both. According to the Society of Reproductive Surgeons, infertility affects men and women equally.

We always recommend that both the male and female partner participate in initial consultations to help determine which partner, or if both, may need testing. In about 10% of couples, fertility testing doesn’t discover a definitive cause for inability to conceive, which results in a diagnosis of unexplained infertility.

By evaluating test results, our fertility specialist is able to take a holistic look at where complications are present and what treatments would best cure infertility. Our practice understands that getting tested for infertility can be emotional and a sensitive topic for some patients. Our goal is to carefully explain all the testing steps and discuss results to help patients understand potential paths forward. Depending on each patient’s unique journey to growing a family, treatments may require a simpler approach or more complex assisted reproductive technologies may be required.

Infertility testing for women

Infertility testing for women generally includes a combination of the specific evaluations below.

A physical exam

Our fertility specialist will complete a pelvic and gynecological exam, in addition to a discussion on medical history and attempts to conceive. The patient’s history assists with diagnosing the cause of infertility and establishing if further testing should be done.

Ultrasound

Ultrasound is an imaging method used to look for polycystic ovary syndrome (PCOS), larger ovarian cysts and sometimes to confirm ovulation is occurring. We also use ultrasound to check for abnormalities in the uterus that can cause problems, including the condition and thickness of the lining.

Ovarian reserve testing

Ovarian reserve means a woman’s potential to get pregnant as calculated by the number and quality of the eggs remaining in her ovaries. As a woman ages, her ability to get pregnant decreases due to having fewer eggs and eggs of reduced quality.

This decrease in pregnancy potential is different for each individual. Ovarian reserve testing helps us determine a woman’s chances of getting pregnant with her own eggs.

Follicular ultrasound for antral follicle count

We may conduct an antral follicle count using follicular ultrasound that gives immediate results. Patients know their follicle count while the doctor performs the ultrasound, so there is no waiting and no anxiety. An antral follicle count helps predict the number of eggs available in a woman’s ovarian reserve. The number of follicles growing on the surface of a woman’s ovaries can reveal how many eggs we could expect to retrieve from ovarian stimulation in fertility treatments like in vitro fertilization (IVF).

Anti-Müllerian hormone (AMH) levels

An AMH test, a blood test that measures levels of the anti-Müllerian hormone, can also help evaluate ovarian reserve. Ovarian follicles secret AMH, AMH level declines with age, and a higher level generally indicates the ovaries have a larger reserve of eggs. Higher AMH levels aren’t always a good thing. AMH may be high in some people with polycystic ovary syndrome (PCOS).

Average AMH level: Between 1.0 ng/mL to 3.0 ng/mL.

Low: Under 1.0 ng/mL., which the Society for Assisted Reproductive Technology says can be predictive of low response to ovarian stimulation in fertility treatments.

Severely low: 0.4 ng/mL

Although AMH levels can’t reveal if patients have a condition that might make it difficult to conceive or how quickly their egg count is decreasing, it does provide a good indication of egg count. The test can help us conclude if a patient is a good candidate for using her own eggs in fertility treatment.

FSH levels

Follicle-stimulating hormone (FSH) stimulates the follicles on a woman’s ovaries to produce a mature egg. As ovarian function diminishes with age or due to other health issues, more FSH needs to be released. An elevated FSH level may mean the ovaries are not producing mature eggs that sperm can fertilize.

Additional hormonal fertility tests

A blood test can help assess hormonal balances, as a woman’s ability to conceive is determined largely by the balance of reproductive hormones in her body. If hormones are not secreted in the right amounts and at the right times, a woman’s reproduction process can be affected.

Hysterosalpingogram and sonohysterogram

Hysterosalpingogram (HSG) is an X-ray test to check the shape of the uterus for any growths, like fibroids or polyps, that can affect conception. It can also determine if the fallopian tubes are open or blocked. Fallopian tube blockage is a common cause of infertility in women.

Sonohysterogram is a procedure to evaluate the inside of the uterus. It includes placing sterile liquid inside the uterus with a catheter, and then an evaluation is done via ultrasound.

Hysteroscopy and laparoscopy

Hysteroscopy is a common test for infertility in women. Hysteroscopy examines the cervix, inside of the uterus and part of the fallopian tubes by placing a telescope-like camera through the cervix into the uterus. This is done if an HSG exam showed possible abnormalities or was inconclusive. Using special instruments, corrective procedures can be done during hysteroscopy. An endometrial biopsy can also be done during this exam.

Laparoscopy is a procedure that enables a doctor to look directly into the pelvic area and at the organs. This is a minimally invasive surgery with small incisions and a camera for viewing the pelvic area to detect causes of infertility. It is usually done when symptoms suggest possible endometriosis.

Laparoscopy can evaluate for blocked fallopian tubes, or in some cases, unexplained infertility. Like hysteroscopy, surgical corrections can be made at the same time the surgeon uses laparoscopy for diagnosis.

Male infertility testing

Male infertility is a condition in which a man’s sperm is not able to fertilize the egg or reach a woman’s egg during intercourse. This can occur for a variety of reasons, including poor sperm health, anatomical problems or erectile dysfunction. According to the American Society for Reproductive Medicine, in approximately 40% of infertile couples, the male partner is either the sole cause or a contributing cause of infertility.

Physical exam and health history

A physical exam helps the doctor identify potential problems and can be used as a measure for additional testing methods.

Identifying visible abnormalities and having an open discussion with the patient about his medical history and lifestyle habits can help our doctor begin to look at possible reasons for infertility and plan additional tests.

Semen analysis

Because sperm problems are a primary cause of male infertility, a complete semen analysis is one of the most essential male infertility tests. This test can be used to establish problems in the sperm’s ability to fertilize a woman’s egg. The sperm may have poor morphology (shape), inadequate movement to get to the egg, or be present in low amounts or concentration in the semen.

The man will need to provide a semen sample. The semen must be tested quickly before the sperm begin to die. Consequently, the man will usually provide a sample in a private room at a lab by masturbating, and the semen is collected in a sterile container.

If the sample is collected by masturbation at home or during sex by using a special type of condom provided by our clinic, the sample will need to be kept at body temperature and taken to the lab within 30 to 60 minutes after collecting it. Sperm count and semen quality can vary from day to day, which may require the patient to provide two or more semen samples within a week or two.

Prior to providing a sample, men should refrain from ejaculating for two to five days for maximum sperm count. Sexual activity should not be avoided beyond this as it could result in less active sperm. In the days preceding a test, men should also avoid:

• Alcohol.
• Tobacco.
• Drugs.
• Excessive caffeine.
• Excessive heat to the scrotum (such as in hot tubs or saunas).

The results of a semen analysis may also suggest additional testing, depending on a man’s personal health history.

Genetic testing

If the semen analysis shows a low sperm concentration, it may indicate a genetic cause for infertility. This can be confirmed through genetic testing of blood samples.

Other male infertility tests

Urinalysis

A urinalysis, which tests a man’s urine, may be ordered in conjunction with other tests. If a semen analysis shows a high white blood cell count, a urinalysis may follow to test for additional white blood cells and antibodies.

Results that are abnormally high could indicate an infection or inflammation. Sperm cells in the urine may suggest retrograde ejaculation, in which ejaculated semen travels back to the bladder instead of out of the penis. This can be revealed by an ejaculatory urinalysis tests.

Hormone test

Male hormones, including testosterone, are an integral part of sperm production and sexual development, so a blood test is commonly administered to examine hormone levels.

Scrotal ultrasound

Testicle obstruction may be found through an ultrasound of the man’s scrotum. A transrectal ultrasound evaluates the vesicles and ejaculatory ducts that transfer semen to see if there is a problem in this area.

Next steps to schedule a fertility consultation

At Ember Fertility Center, we offer appointments within two business days to help patients get started on their path to parenthood. Each Ember patient has a dedicated fertility patient coordinator, a patient’s personal care guide – from the initial phone call to the last visit. Much like a VIP’s personal assistant, our patient coordinators get to know each patient and their story, goals, concerns and preferences.