An in-depth guide to fertility testing
When you have your first visit with your fertility specialist, they will review you and your partner’s medical history. The next step is fertility testing. It can help identify potential problems and help your fertility specialist recommend the most appropriate and efficient treatments. Here is our guide to fertility testing.
The guide to fertility testing – Bloodwork
Typically, fertility testing will include the following four tests. Bloodwork, ultrasound, hysterosalpingogram (HSG) for ‘her’ and semen analysis for ‘him’. Here’s a deeper look at our guide to fertility testing.
Bloodwork: For some patients, especially for women who are 35 years or older, bloodwork occur on the third day of your menstrual period. If it is inconvenient to go on this particular day, day 2 or 4 of your menstrual period are okay. The third day of your period is two days after the first day of red, heavier flow.
FSH/estradiol: To test ovarian function, your specialist may order levels of FSH (follicle stimulating hormone) and estradiol. Your brain produces FSH and your ovaries produce estradiol. A normal level for FSH is <10 miu/ml. Between 10-15 miu/ml is ‘borderline.’ Above 15 is very concerning for diminished ovarian function.
It is important to test estradiol along with FSH because a high estradiol can ‘mask’ a high FSH. A normal level for estradiol is <50 pg/dl. Between 50-80 pg/dl is ‘borderline.’ Above 80 pg/dl is concerning for diminished ovarian function. Thus, an ideal test result would both a low FSH and a low estradiol level.
TSH: Your specialist may screen for a thyroid problems with a TSH (thyroid stimulating hormone) test. Thyroid problems can contribute to irregular or absent periods and thus problems with infertility.
Prolactin: This is a hormone that, if elevated, can subtly or significantly change your menstrual pattern. Thus, your provider may check this as well.
Other types of testing for women
Ultrasound/examination: It is important to rule out general physical problems and evaluate the uterus and ovaries. Depending on your situation, your fertility specialist may want this done during a certain time of your menstrual cycle.
Physical examination: This commonly involves listening to your heart and lungs. It also having a brief pelvic examination.
Ultrasound: This ultrasound is commonly occurs internally (via the vagina) because it gives much better pictures and information than an abdominal ultrasound about the pelvic anatomy. This ultrasound helps your doctor to identify certain abnormalities of the uterus. It also gives important information about the ovaries.
Hysterosalpingogram (HSG): Since the ultrasound generally gives no information about the fallopian tubes, it is important to look at them using an HSG. This test involves placing a thin catheter into the uterus and injecting dye into the cavity of the uterus.
This dye shows up on x-ray, and pictures are taken during this test to determine whether both fallopian tubes are open. This test can also give more information about the inside of the uterus. This test is generally short (about 15-20 minutes usually), but it can cause cramping. Consider talking to your nurse about taking extra pain medication (e.g. ibuprofen) 30-60 minutes before the procedure.
A test for the men
Semen analysis: As sperm problems affect around 30% of couples with infertility, it is important to do a semen analysis to identify any issues. After 2-5 days of abstinence, the male partner can provide a semen sample into a sterile cup. This can occur at home if the couple lives within an hour of the clinic. Alternatively, a collection room can be available. Usually collection is done via masturbation; however, a ‘collection condom’ can be used to collect sperm during intercourse. The semen analysis will give information about sperm numbers, the percentage of sperm moving, and the percentage of sperm that look ‘normal’. Certain treatments are not successful with low numbers of moving sperm, so this is important information for your fertility specialist to have.
The above tests are commonly done for couples having problems with fertility. Your doctor will let you know if there are further tests to consider for your specific situation. After basic testing, the next step will typically be a consult visit with your doctor to determine the best approach to get you closer to your goal of growing your family! Contact us to get started.