What You Need To Know About Fertility Testing

You and your partner haven’t been able to conceive after trying for more than six months. Or you are able to get pregnant, but then have miscarriages. You are probably feeling all the emotions – from anger to depression. It might be time to seek help from a fertility expert. So what kind of tests can you expect to endure while your doctor investigates the cause of your infertility – or evaluates your fertility potential? Here’s everything you need to know as your start the testing phase of your fertility journey:

Male Fertility Testing

First thing to remember – a successful pregnancy is a result of team effort. When there are difficulties conceiving – both partners must be tested.

Men will experience a physical examination to check for a varicocele, a varicose vein present on the scrotum, or other abnormalities that can impact sexual function or sperm production.

Men will also provide a sperm sample that will be assessed by a laboratory professional based upon six parameters:

1. Volume – The normal volume in a sperm sample is between ¼ -1 teaspoon, or 1.5-5 mL. Low volume can indicate dehydration but could also be due to a blockage or dysfunction.
2. Sperm Concentration – A normal concentration is approximately 15 million or higher. Lower numbers may indicate a blockage or issue with sperm production.
3. Motility – This focuses on the sperm’s ability to move and should be above 40 percent. A lower number may indicate exposures to things such as smoking, alcohol, caffeine, chemicals, or drugs. Low motility can also indicate hormonal problems or a varicocele.
4. Morphology – This focuses on the shape of the sperm, which includes the head and tail. Chances of pregnancy decrease if there is a large presence of abnormally shaped sperm. This may also affect recommendations on treatment to optimize your fertility potential
5. Total Motile Count – The total amount of moving sperm. Normal sperm samples have at least 20 million moving sperm, optimally 40 million or more. Intrauterine Insemination may be helpful if the total motile count is between 10-20 million (minimum 5-10 million). In Vitro Fertilization may be recommended when there are less than 10 million moving sperm.
6. Other factors such as the presence of white blood cells or increased round cells may indicate inflammation or infection.

For the best results, men must abstain from sexual activity between 2 to 5 days before producing a specimen.

Female Fertility Testing

After your initial consultation with your fertility doctor, most women will have a physical examination and a vaginal ultrasound to evaluate the reproductive organs (ovaries, uterus, cervix, fallopian tubes). During the ultrasound examination a healthcare provider will take measurements of the uterus and look for abnormalities such as thin or thick uterine lining, suspicious polyps or the presence of fibroids. Ovaries will be evaluated for cysts, volume and an antral follicle count (AFC) is completed. A saline-infused sonogram with a 3D ultrasound can help evaluate whether the fallopian tubes are open and further assess the uterine cavity.

Blood Tests

Women will also take blood tests to evaluate ovarian reserve and hormones. These are the most common tests that women take:

• Anti-Mullerian Hormone: AMH is a hormonal indicator of egg supply. This blood test can be done any day of the month as AMH levels do not fluctuate very much over the course of a menstrual cycle. When AMH levels are normal, it indicates a strong egg supply. Low AMH can indicate a low ovarian reserve while a high AMH can indicate the possibility of Polycystic Ovarian Syndrome (PCOS).
• “Day 3” Follicle Stimulating Hormone: This blood test measures ovarian function which then correlates to fertility potential. This hormone is released from the brain and stimulates the ovary to grow eggs. FSH levels increase as your supply of eggs decreases. This blood test can be done between day 2 and day 4 of your menstrual cycle. A high FSH level may indicate a declining/low egg supply or the onset of menopause. A low FSH may sometimes be seen as a reason for lack of ovulation and amenorrhea (no periods).
• Estradiol: The levels of the hormone Estradiol helps to validate the FSH level, further confirming ovarian function and fertility potential. The best time to have these tests performed is between day 2 and 4 of the menstrual cycle.
• Luteinizing Hormone: A rise in LH indicates that ovulation is occurring. Testing for this hormone during your cycle may evaluate whether this hormone is present to trigger ovulation.

Optional Testing

Genetic Testing: Completing genetic testing can uncover whether you are a carrier of genetic disease or currently have a genetic disease that could impact fertility potential. This test can be done through a blood test or even through collection of saliva. If genetic abnormalities are present, patients may choose to pursue genetic testing (PGT-A or PGT-M) of embryos to prevent genetic issues from being passed down.

Testosterone: Higher levels of testosterone in a woman can indicate the presence of a medical issue such as Polycystic Ovarian Syndrome, or PCOS, which can impact ovulation. Men with abnormal testosterone levels may also experience issues with sperm production.

Prolactin: This hormone is released from your brain and abnormal prolactin levels can cause fertility issues for women (and men too). If women are experiencing irregular or no periods, breast tenderness or breast milk discharge, a reproductive endocrinologist will order a test to assess prolactin levels.

Thyroid-Stimulating Hormone:  A thyroid that is overactive or underactive can cause fertility issues, irregular ovulation and inconsistent monthly periods. TSH levels that are off can also cause additional hormone imbalances, such imbalanced prolactin levels.

Do-It-At-Home Testing

How much are all of these tests going to cost? It depends on your insurance – and your fertility clinic. Most of these tests are covered by insurance. Also, some fertility clinics will remove the testing fees completely or apply the costs to future treatments – if you decide to stay with their clinic for other procedures like IVF or IUI.

There are some over-the-counter fertility testing kits you can do at home. However, some people are not good candidates for the do-it-yourself preliminary tests:  If a woman has irregular periods, has been diagnosed with or suspects she has PCOS, endometriosis, fibroids, ovulatory disorders, damage or blockage of the fallopian tubes, or has undergone any cancer treatment – she should skip the home tests and see a specialist.  Also, if a man has undergone cancer treatment, is on any medication that can hinder fertility such as testosterone, has difficulty achieving or sustaining an erection, is taking supplements for athletic performance, suspects semen issues, or has experienced any trauma to the genital area, he should see a doctor.