Fertility testing is an essential tool for heterosexual couples, intended single parents, and LGBTQ+ couples and individuals who want to take charge of their reproductive health and make informed decisions about fertility care. Whether you’re ready to become a parent now or are interested in fertility preservation, fertility testing provides the information you need to create your family-planning roadmap.
There are various types of female fertility tests available, ranging from simple blood tests to more complex procedures, such as ultrasounds and hysterosalpingograms. The results of these tests can provide insight into a woman’s ovarian reserve, hormone levels, and reproductive anatomy.
Loss of eggs is one of the reasons for lower fertility and higher miscarriage rates seen in women as they age. Tests to assess ovarian reserve are useful for both the physician and couple experiencing infertility as they provide a more complete understanding of the likelihood of a woman conceiving with her own eggs.
However, there are limitations to all tests such that some women with poor or abnormal results may still conceive a healthy child with their own eggs while others with normal results could still have unhealthy embryos with continued infertility. Several tests are now available to assess egg reserve.
Follicle-stimulating hormone (FSH) is a hormone produced by the pituitary gland in the brain that provides an indirect measure of ovarian functioning. Test results can vary from menstrual cycle to menstrual cycle, making the results less reliable.
Anti-Mullerian hormone (AMH) is a hormone that is generated within the ovary and therefore considered to be a more direct measure of egg health. Unlike FSH, blood work can be obtained at any time during the cycle and the level shows less cycle-to-cycle variability.
Antral follicle count (AFC) is obtained using transvaginal ultrasound measurements, usually early in the menstrual cycle. The size of the ovaries and the number of visible immature follicles present early in the cycle have been demonstrated to reflect the number of eggs that have the potential to develop during a treatment cycle.
Hysterosalpingogram (HSG) is an X-ray procedure that is useful in determining if the fallopian tubes and uterus are normally structured, and if the tubes are open.
A saline infusion sonogram is routinely performed to make sure that the inside of the uterus appears normal. Benign uterine growths, such as endometrial polyps or uterine fibroids, may develop in the cavity and create an environment that is hostile to embryo implantation.
The decision of whether or not it’s time to see a fertility specialist for female fertility testing largely depends on the circumstances. In general, fertility experts recommend that women under the age of 35 who have been actively trying to conceive see a fertility specialist for testing after one year of trying. For women who are over the age of 35, it’s recommended that you undergo female fertility testing after six months. However, if you are interested in fertility preservation, have a reproductive condition (e.g., endometriosis, PCOS, etc.), or have a family history of fertility issues, you should consider scheduling a fertility testing consultation as soon as possible.
In general, fertility testing should not be a painful experience. Hormone levels are measured through blood tests, which involve drawing blood from a vein using a needle. While this can cause discomfort for some patients, it’s typically considered to be a tolerable procedure. Tests that involve inserting a speculum into the vaginal canal can also cause discomfort for some, but most patients report these tests as being similar to a pelvic exam.
Fertility testing captures the full picture of what’s going on in your reproductive system, including your hormones, reproductive anatomy, ovarian reserve, and more. All of this information can be used to garner a better understanding of how likely you are to achieve pregnancy with or without fertility treatments. That being said, fertility testing cannot predict with absolute certainty your chances of getting pregnant.
If you are planning on undergoing fertility testing, it’s recommended that you start tracking your menstrual cycle for at least a few months before the test. It’s also recommended that you avoid taking certain medications. Your doctor will advise you on any other instructions you may need to adhere to before the test, such as fasting before a procedure.
Approximately 40% of infertility in heterosexual couples is attributable to male factors, and another 20% of infertility cases involve both female and male issues. Some of the factors may be suspected or known before attempting conception, while most might not be anticipated.
Given the significant percentage of male infertility cases associated with sperm abnormalities, a semen analysis should be among the first tests performed on aspiring parents experiencing unexplained infertility.
Certain medical conditions or exposure to toxins can lead to damage to the sperm-producing cells or affect the release of sperm. Conditions such as undescended testes not corrected within the first year of life, cystic fibrosis, diabetes, cancer, or other chronic illnesses may also affect sperm production and/or release. Other risk factors for male infertility and/or inhibited sperm production include exposure to chemotherapy, radiation, use of supplements containing androgens (including Testosterone, DHEA, and gym workout aids), certain herbs, over-the-counter medications, and prescribed medications.
In some cases, toxin exposure or ingestion can permanently destroy the cells that produce sperm, resulting in sterility. The use of hot tubs, excessive alcohol ingestion, tobacco use, and marijuana consumption can all have adverse effects on sperm production and function. However, in other cases, there are no known exposures, health issues, or family history to account for abnormalities.
The evaluation of the semen sample includes numerous factors including concentration (number) of sperm, motility (percentage of sperm moving or swimming), and morphology (sperm shape). In addition, viscosity (thickness/ability to liquefy), presence of bacteria or white blood cells, and pH are observed. Significant abnormalities in any of these parameters will decrease the likelihood of a sufficient number of sperm being able to reach or penetrate the egg.
The specimen is collected by masturbation into a collection container after abstaining from ejaculating for 2-5 days. If significant abnormalities are detected on repeated semen analysis studies, a consultation with a urologist who has special training in male infertility may be recommended.
Treatment options vary depending on the results of the evaluation and the degree or severity of the abnormalities found on the semen test. The most important initial steps include eliminating toxin exposures (including alcohol, tobacco, illegal drugs, and any form of male hormone precursors or supplements), avoiding excess heat exposure, and maintaining a healthy diet including foods rich in folic acid and antioxidants.
A urologic evaluation may reveal a problem that can be treated medically or surgically. If alterations in lifestyle do not improve semen parameters and no medical or physical problem contributing to the poor sperm qualities can be identified, then treatment options can include sperm concentration and placement into the uterus (intrauterine insemination/IUI) or in vitro fertilization (IVF) with the injection of a single sperm into each egg (intracytoplasmic sperm injection/ICSI).
A semen sample is generally considered normal when it has the following criteria:
Anything below these thresholds may indicate a fertility issue.
Yes, a man with abnormal semen parameters may still be fertile enough to impregnate someone naturally. Fertility is complex and semen parameters are only one factor that plays a role in male fertility. However, it’s important to note that abnormal semen parameters strongly correlate with fertility issues and difficulties conceiving.
Before semen analysis, men must abstain from all forms of ejaculation for 2-5 days before the test. This ensures that the provided semen sample contains an accurate measure of the patient’s average sperm parameters. Men should also avoid alcohol, drugs, tobacco, high-heat situations (e.g., saunas, hot tubs, etc.), and tight-fitting underwear for at least a few days before the test. Be sure to discuss everything with your doctor before, as there may be specific instructions that need to be followed or medications to be avoided.
If a semen analysis yields any abnormal results, a second semen analysis will be scheduled to confirm the results. If the test continues to produce abnormal results, additional semen analyses will be scheduled. The tests are typically scheduled at least seven days apart from each other over the course of several months.
At The Reproductive Medicine Group, we have many years of experience diagnosing the full spectrum of male and female infertility issues in Florida. With locations in North Tampa, South Tampa, Brandon, Clearwater, and Wesley Chapel, our expert team of fertility specialists is ready to answer all your questions and provide personalized fertility care.
