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What to Expect During Fertility Tests

Fertility Tests for Men and Women

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Updated September 15, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Fertility tests are an important step towards finding the right treatment.

Fertility tests are an important step towards finding the right treatment.

Photo: Keith Brofsky / Getty

Fertility tests are an essential part of fertility evaluation and treatment. Through testing, your doctor can possibly discover what's preventing you and your partner from achieving pregnancy. Your regular gynecologist may do some basic testing, or you may be referred to a reproductive endocrinologist (a doctor specializing in fertility) or a urologist (for male infertility) for 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:

  • A basic gynecological exam

  • Sexually transmitted disease testing (some STDs can cause infertility)

  • Blood work, which may check for thrombophilia and antiphospholipid syndrome (in cases of recurrent miscarriage), as well as a variety of 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 your menstrual cycle. For example, FSH is usually checked on day 3 of your cycle, and progesterone is usually checked on day 21 of your cycle.

  • Ultrasound, to look for polycystic ovaries, larger ovarian cysts, fibroids, and, sometimes, to confirm ovulation is taking place.

    Ultrasound is also 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, 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). This test is not commonly done.

  • Hysteroscopy, which 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. Your doctor may also do an endometrial biopsy during this exam.

  • Sonohysterogram, which involves placing sterile liquid inside the uterus (via a catheter), and then evaluating the uterus and uterine walls via ultrasound.

  • Diagnostic laparoscopy, which may be 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

  • STD testing

  • Ultrasound, to evaluate the seminal vesicles and scrotum

  • Post-ejaculatory urinalysis (urine testing), to check for retrograde ejaculation

  • Testicular biopsy, which involves the removal of testicular tissue via a minor surgical procedure

  • Vasography, which is a specialized x-ray that is used to look for obstructions of the male reproductive organs

Couple Fertility Tests

Some fertility tests involve both partners. If recurrent miscarriage is a problem, genetic karyotyping may be done to look for genetic disorders that may lead to miscarriage. This is done through a simple blood test.

Though rarely done anymore, post-coital testing (PCT) involves taking a sample of cervical mucus from the woman via a pelvic exam, several hours after the couple has sexual intercourse. It evaluates the interaction between the woman's cervical mucus and the man's sperm.

After Fertility Testing

Once fertility testing is complete, you'll meet with your gynecologist or reproductive endocrinologist to discuss what the results mean, what treatment would be appropriate, and decide the next step to take.

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Sources:

A Basic Guide to Male Infertility: How to Find Out What's Wrong. American Urologic Association. Accessed December 20, 2009. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/patient-guides/whatswrongpg.pdf

Patient Fact Sheet: Diagnostic Testing for Male Factor Infertility. American Society of Reproductive Medicine. Accessed December 20, 2009. http://www.asrm.org/Patients/FactSheets/Testing_Male-Fact.pdf

Patient Fact Sheet: How Doctors Evaluate Infertility in Women. American Society of Reproductive Medicine. http://www.asrm.org/Patients/FactSheets/InfertilityInWomen.pdf

Patient Fact Sheet: Recurrent Pregnancy Loss. American Society of Reproductive Medicine. Accessed December 20, 2009. http://www.asrm.org/Patients/FactSheets/recurrent_preg_loss.pdf

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