Infertility Tests

What are infertility tests?

Infertility tests help find out why you cannot get pregnant. These tests include a physical exam, semen analysis, blood tests, and other procedures.

Many of these tests are done in your doctor's office or clinic. Some other procedures may be done in a hospital.

Should you be tested?

Before you have infertility tests, you may want to try fertility awareness methods to find the best time to become pregnant. If you have regular periods, you are probably able to get pregnant for about 6 days each month. This includes 5 days before you ovulate to the day after you ovulate. Some people find that they have been missing the most fertile days when trying to become pregnant. You may want to keep track of your menstrual cycle and when you ovulate. And your doctor will probably want you to track how often you have sex. This record will help your doctor if you decide to have infertility tests.

Think about getting tests if:

• There is a physical problem. These problems may include not being able to release sperm (ejaculate), not ovulating, or having irregular menstrual cycles.
• You are in your mid-30s or older, haven't used birth control for 6 months, and haven't been able to become pregnant.
• You are in your 20s or early 30s, haven't used birth control for a year or more, and haven't been able to become pregnant.

Infertility tests may find what is causing the problem. You can sometimes be treated during the tests. For example, a blocked fallopian tube may be opened during a hysterosalpingogram.

Sometimes tests can't find the cause of infertility. And not all infertility problems can be treated. But you may still be able to become pregnant using assisted reproductive technology.

If you decide to have infertility testing, talk with your doctor about how much testing you are willing to do and for how long. Testing and treatment can be stressful, costly, and sometimes painful. You may need only a few tests, or you may need many tests over months and years. You may only want to have tests for problems that you are willing to treat or tests to find out if you might need to consider other options, such as adoption.

How do the tests feel?

Some tests, such as a semen analysis, a physical exam, and blood tests, don't cause pain. But some procedures, such as a laparoscopy or a hysterosalpingogram, may cause some pain.

What are the risks of infertility tests?

Simple tests, such as semen analysis, blood tests, or an ultrasound, don't usually cause any problems. Other tests that are medical procedures, such as a hysteroscopy or a laparoscopy, have a higher chance of problems after the test.

Where are the tests done?

Many infertility tests can be done in your doctor's office or clinic by an obstetrician or a reproductive endocrinologist. Some medical procedures are done in an operating room. Your internist or family medicine physician may do some of the first tests. Other tests may be done by a urologist or gynecologist.

What tests are done first?

Infertility tests are done to help find out why you can't get pregnant. Your doctor will first get your medical history and do a physical exam. You may also have other tests to check for specific problems.

• Medical history. Your doctor will ask questions about your sexual activity and your birth control methods. They will ask you about any sexually transmitted infections (STIs), medicine use, and the use of caffeine, tobacco, alcohol, marijuana, or illegal drugs. Your menstrual cycle and exercise patterns will be checked. If STIs are suspected, more tests may be done.
• Physical exam. You will have a complete physical exam to check your health. This may include a pelvic exam or a testicular exam. If there is a problem with the semen, sometimes a doctor will refer you to a urologist.
• Blood or urine tests. You may have blood and urine tests to check the levels of certain hormones. These may include:
  • Luteinizing hormone (LH) and progesterone tests. These may be done during the menstrual cycle to help see if you are ovulating. LH may be checked to see if there is a pituitary gland problem.
  • Thyroid hormone and thyroid-stimulating hormone (TSH) tests. These may be done to check for thyroid hormone problems that may be preventing ovulation.
  • A prolactin test. Prolactin is a hormone made by the pituitary gland. It may be checked if you have menstrual cycle or ovulation problems.
  • The anti-mullerian hormone test. This is a blood test that is sometimes used to check the egg supply (ovarian reserve). It may be used if you are thinking about having in vitro fertilization (IVF). Anti-mullerian levels go down as the egg supply decreases. This usually happens with age.
  • A follicle-stimulating hormone (FSH) test. In some cases, this test may be used to look at the egg supply (ovarian reserve). FSH testing may also be used when there is a very low number of sperm to try to find out the source of the problem.
  • A testosterone test. This test may be used to see if there is a problem with the testicles or pituitary gland. A low amount of testosterone can lead to low sperm counts.
  • Tests for sexually transmitted infections (STIs).These may include urine samples, blood samples, or samples from the cervix.
• Semen analysis. A semen analysis checks the number of sperm (sperm count), the number of sperm that look normal, the number of sperm that can move normally, the number of white blood cells in the semen, and how much semen is made.
• Ultrasound. You may have an ultrasound to look at your reproductive organs.
  • Pelvic ultrasound. This looks at the size and structure of the uterus and both ovaries. It can also be used to check a egg supply (ovarian reserve). This is done by counting the number of follicles in both ovaries during a certain phase of the menstrual cycle.
  • Testicular and transrectal ultrasound. These can look for problems in the testicles which may be causing problems with the sperm.
  • Sonohysterogram. This is a special ultrasound test that uses saline and ultrasound to look at the uterus and fallopian tubes.
• X-ray. You may have a special kind of X-ray called a hysterosalpingogram. It may be done to look at the inside of the uterus and fallopian tubes. The pictures can show a blockage of the fallopian tubes or see problems inside of the uterus.

What other tests may be done?

If other tests don't find a reason for your infertility, or if your infertility treatment hasn't worked, one or more of these tests are sometimes used.

• Antibody blood tests. These tests look for antisperm antibodies in blood, semen, or vaginal fluids. But some doctors question the value of these tests for finding the cause of infertility.
• Genetic tests. These tests may be done to help find the cause of infertility.
• Chromosome analysis. A test that looks for problems in the genetic material (chromosomes) in your cells. Some of these problems make it hard to become pregnant. Or they can cause miscarriages.
• Ultrasound. It uses sound waves to make a picture of structures inside the body. It may be done to see if a problem in the testicles is causing a problem with the sperm. It may also be done to see if there are any problems in the uterus or ovaries.
• Testicular biopsy. In rare cases, when there are few sperm or no sperm in the semen, a biopsy may be done to check for sperm in the testicles.
• Hysteroscopy. This procedure looks at the lining of the uterus using a thin, lighted scope that is put through the vagina and cervix into the uterus. This test is used to find problems in the uterine lining. Sometimes the doctor can use small tools during the procedure to take out growths or take samples of tissue (biopsy) or open a blocked fallopian tube.
• Laparoscopy. Laparoscopy looks at the pelvic organs (uterus, fallopian tubes, and ovaries). It's done using a thin, lighted scope that is put through a small cut (incision) in the belly. This procedure is used to find cysts, scar tissue (adhesions), fibroids, and infections that can affect fertility. Laparoscopy can also be used to treat conditions, such as endometriosis. It's often done with general anesthesia.