Fertility Testing

The American College of Obstetricians and Gynecologists recommends:

• Fertility tests for anyone who is at risk for infertility or infertile
• Expedited fertility tests for women above 35 years

However, an immediate fertility test is recommended by the American College of Obstetricians and Gynecologists if you:

• Are above 40 years
• Have any conditions that are known to cause infertility
• Experience oligomenorrhea—inconsistent or irregular menstruation
• Have suspected or known tubal, uterine, or peritoneal disease
• Experience amenorrhea—the absence of menstruation
• Have stage III or IV endometriosis, a disorder with endometrial tissue outside of the uterus

Your response to donor insemination can be an indication of the need for a fertility test. If you are younger than 35 and fail to get pregnant within 12 months of therapeutic donor insemination or older than 35 and fail to get pregnant within 6 months, you may need fertility tests, reports the American College of Obstetricians and Gynecologists.

You can get a fertility test from your ob-gyn. However, your primary care provider may refer you to a reproductive endocrinologist, a specialist with expertise and training in reproduction, for the evaluation and treatment of infertility. Solv can help you find a top-rated reproductive endocrinologist close to you to help you schedule an appointment immediately.

During your initial appointment with the reproductive endocrinologist, you can usually expect them to obtain a thorough reproductive, medical, and family history and conduct a physical examination.

History

You can expect your doctor to ask about the duration of infertility, menstrual history, obstetrical history, timing, and frequency of sexual intercourse, as well as your social history. Your doctor will inquire about smoking, alcohol consumption, exercise, occupation, diet, and illicit drug use.

According to the National Library of Medicine (NLM), acute and chronic infections in the abdomen and pelvis can lead to tubal/pelvic adhesions. These adhesions account for a significant amount of infertility. You can expect your doctor to ask about a history of sexually transmitted diseases (STDs). According to the American Society for Reproductive Medicine, the initial visit is an appropriate time to provide prepregnancy counseling and screen for applicable genetic conditions.

Physical examination

The NLM notes that you can expect the healthcare provider to take your vital signs and measure your body mass index (BMI). Your doctor will also typically evaluate your thyroid, examine your breasts for milky discharge, and examine your skin and genitalia for signs of androgen excess. The physical examination will include an evaluation of the vagina and cervix for abnormalities, pelvic tenderness or masses, and an enlarged or irregular uterus. According to the NLM, a bedside transvaginal ultrasound may be done during the initial visit.

According to Planned Parenthood, infertility may be difficult to identify. The only signs that suggest infertility are difficulty getting pregnant or keeping a pregnancy. The definite way to determine if you have infertility is to consult a doctor and have a fertility test done.

Fertility tests typically focus on ovarian function, structural abnormalities, and ovarian reserves.

How to assess ovarian function

The menstrual history may provide information about ovarian function. Your doctor will ask questions about your menstrual flow, the regularity of your cycle, and symptoms of breast tenderness, fatigue, and bloating to assess ovulation. You can use an at-home luteinizing hormone (LH) predictor kit to identify a mid-cycle rise in LH levels. The surge in LH is indicative of ovulation. According to the NLM, measurement of the levels of hormones like progesterone a week before your menses may provide evidence of ovulation and ovarian function.

How to measure ovarian reserve

Ovarian reserves refer to the capacity of the ovaries to produce eggs that can become fertilized. Women with low ovarian reserves may have regular menses but a diminished response to ovarian stimulation. Your doctor may perform a biochemical analysis and an ultrasound of the ovary to assess your ovarian reserve. According to the American Society of Reproductive Medicine, several measurements of hormones, including the basal follicle-stimulating hormone (FSH) and estradiol, and antimullerian hormone, provide information about the ovarian reserve. Your doctor will obtain a level of basal FSH and estradiol between the second and fourth days of your menstrual cycle.

How to assess structural abnormalities

According to the American Society of Reproductive Medicine, structural abnormalities like blocked tubes, pelvic abnormalities, cervical disorders, and uterine abnormalities affect infertility. Your doctor may need to make an assessment:

• Your doctor may need to perform tests to evaluate structural abnormalities. A cervical examination may be done to identify the narrowing of the passage or chronic inflammation.
• Uterine abnormalities, including polyps, fibroids, and adhesions, are common in women with fibroids. According to the American Society of Reproductive Medicine, ultrasound is the best test for assessing the anatomy of the uterus to identify abnormalities. Your doctor may use an instrument called hysteroscopy to evaluate the uterine cavity and remove lesions. A saline infusion sonogram (SIS) is a less invasive way to view uterine abnormalities.
• Tubal disease can cause a blockage in your fallopian tubes and prevent pregnancy. Your doctor may perform an imaging study called hysterosalpingography to evaluate the patency of your tubes.
• Peritoneal factors that cause infertility include pelvic or adnexal adhesions and endometriosis. According to the NLM, a laparoscopy is done when there is suspected endometriosis, pelvic adhesions, or disorders within the pelvis. Your doctor may perform a transvaginal ultrasound to assess for endometriosis and laparoscopy to visually pelvic abnormalities that impair infertility.