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Infertility Tests

Infertility Tests

Overview

What are infertility tests?

Infertility tests are done to help find out why a woman cannot become pregnant. The tests help find whether the problem is with the man , the woman , or both. Tests usually include a physical exam, semen analysis, blood tests, and special procedures.

Should I be tested?

Before you have infertility tests, try fertility awareness methods to find the best time to become pregnant. A woman is most fertile during ovulation and 1 to 2 days before ovulation. Some couples find that they have been missing the most fertile days when trying to become pregnant. A woman should keep a record of her menstrual cycle and when she ovulates. This record will help your doctor if you decide to have infertility tests.

To learn more, see the topic Fertility Awareness.

Consider infertility tests for you or your partner if:

  • There is a physical problem, such as not being able to release sperm (ejaculate), not ovulating, or having irregular menstrual cycles.
  • You are in your mid-30s or older, have not used birth control for 6 months, and have not been able to become pregnant.
  • You are in your 20s or early 30s, have not used birth control for a year or more, and have not been able to become pregnant.
Click here to view a Decision Point. Fertility Problems: Should I Be Tested?

How do infertility tests feel?

Some tests, such as a semen analysis, physical exam, and blood tests, do not cause pain. But some procedures, such as an endometrial biopsy , a laparoscopy , or a hysterosalpingogram , may cause some pain.

Do the tests cost a lot?

Infertility tests can cost a lot and cause stress. You and your partner will need to keep track of the frequency of sexual intercourse and talk about this with your doctor.

Before you have infertility tests, talk with your partner about how much testing you want to do. Sometimes you may not find out what causes infertility even after many tests. So it is important to know how many tests you want to try.

What are the risks of infertility tests?

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

Where are infertility tests done?

Many infertility tests, including the physical exam, medical history, and blood tests, can be done in your doctor's office or clinic by an obstetrician or reproductive endocrinologist . Your internist or family medicine physician may do some of the first tests. Tests on a man may be done by a urologist . Some medical procedures are done in an operating room.

What are the benefits of infertility tests?

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

Sometimes tests cannot find the cause of infertility. And not all infertility problems can be treated. Infertility in men is often less successfully treated than infertility in women. But you may still be able to become pregnant using assisted reproductive technology , which can treat male or female problems.

What tests are done first?

Tests to find the cause of infertility
Test Description

Both partners: Medical history

Your doctor will ask questions about your sex life, your birth control methods, any sexually transmitted infections (STIs) , medicine use, and the use of caffeine, tobacco, alcohol, or illegal drugs. Your menstrual cycle and exercise patterns will be checked. If STIs are suspected, more tests may be done.

Both partners: Physical exam

A complete physical exam of both you and your partner is done to check your health.

  • A woman's physical exam usually includes a pelvic examination and Pap test.
    Pap Test
    Pelvic Examination
  • A man's physical exam usually includes a testicular examination. Not all fertility doctors will do a physical examination of the man. If there are problems with the semen, the doctor may refer the male partner to a urologist .
    Testicular Examination

Both partners: Blood or urine tests

  • Luteinizing hormone (LH) and progesterone tests may be done during a woman's menstrual cycle to help see whether she is ovulating. LH may be checked in a man to see whether he has a pituitary gland problem.
    Luteinizing Hormone (LH)
    Progesterone
  • Thyroid function tests may be done to check for thyroid hormone problems that may be preventing ovulation.
    Thyroid Hormone Tests
    Thyroid-Stimulating Hormone (TSH)
  • Prolactin is a hormone made by the pituitary gland. It may be checked if a woman has menstrual cycle or ovulation problems.
    Prolactin
  • The anti-mullerian hormone test is a blood test that is sometimes used to check a woman's egg supply (ovarian reserve). It may be used for women who are considering IVF. Anti-mullerian levels go down as a woman's egg supply decreases, which usually happens with age.
  • In some cases, follicle-stimulating hormone (FSH) may be used to check a woman's egg supply (ovarian reserve). FSH testing may also be used for men with a very low number of sperm to try to find out the source of the problem.
    Follicle-Stimulating Hormone
  • A testosterone test may be used to see whether a problem with the testicles or pituitary gland is preventing a man from being able to father a child. A low amount of testosterone can lead to low sperm counts.
    Testosterone
  • Tests for sexually transmitted infections (STIs) may be done. These may include urine samples or samples from the cervix or urethra .

Male partner: 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.

Semen Analysis

Female partner: Home test

Home LH urine test kits can be used to see when ovulation occurs. Sometimes a woman's basal body temperature (BBT) is also checked at the same time.

Fertility Awareness

What if the first tests do not find a cause?

If the first tests do not find a cause for infertility, the woman may have one or more of the following tests.

Tests for women to find the cause of infertility
Test Description

Pelvic ultrasound

A pelvic ultrasound looks at the size and structure of the uterus and both ovaries . It can check the condition and size of the ovaries during treatment for infertility. It can also be used to check a woman's egg supply (ovarian reserve). This is done by counting the number of follicles in both ovaries during a certain phase of the menstrual cycle (antral follicle count).

Pelvic Ultrasound

Hysterosalpingogram

A hysterosalpingogram is an X-ray test that looks at the inside of the uterus and the fallopian tubes. The pictures can show a blockage of the fallopian tubes that would prevent an egg from reaching the uterus or prevent sperm from moving into a fallopian tube to join (fertilize) an egg. This test may also see problems on the inside of the uterus that might prevent a fertilized egg from attaching (implanting) to it.

Hysterosalpingogram

Sonohysterogram

A sonohysterogram is an ultrasound test that uses saline and ultrasound to look at the female reproductive organs.

Sonohysterogram

Laparoscopy

Laparoscopy is a procedure to look at a woman's pelvic organs (uterus, fallopian tubes, and ovaries) 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 . Laparoscopy is usually done with general anesthesia .

Laparoscopy

What other tests may be done?

If a hysterosalpingogram, laparoscopy, or endometrial biopsy does not find a reason for your infertility, or if your infertility treatment has been unsuccessful, one or more of the following tests are sometimes used.

Other tests to find the cause of infertility
Test name Description

Both partners: Antibody blood tests

Antibody blood tests may be done to find antisperm antibodies in blood, semen, or vaginal fluids. Doctors question the value of antibody tests for finding the cause of infertility.

Antisperm Antibody Test

Both partners: Karyotype (chromosome analysis) or genetic test

  • Karyotyping is a blood test that looks for problems in the genetic material ( chromosomes ) in your cells. Some genetic problems make it hard to become pregnant or cause miscarriages.
    Karyotype Test
  • Genetic tests may be done to help find the cause of infertility.
    Genetic Test

Male partner: Ultrasound

Ultrasound uses sound waves to make a picture of structures inside the body. It may be done to see whether a problem in the testicles is causing a problem with the sperm.

Testicular Ultrasound

Male partner: Testicular biopsy

In rare cases, when men have no sperm in their semen, a testicular biopsy may be done to check the sperm in the man's testicles.

Testicular Biopsy

Female partner: Hysteroscopy

Hysteroscopy is a procedure that looks at the lining of the uterus using a thin, lighted scope that is put through the vagina and cervix into the uterus. Hysteroscopy is used to find problems in the uterine lining. Sometimes your doctor can use small tools during the procedure to take out growths or take samples of tissue (biopsy) or open a blocked fallopian tube.

Hysteroscopy

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Fertility Problems: Should I Be Tested?

Other Places To Get Help

Organization

American Society for Reproductive Medicine
Web Address: www.asrm.org

References

Other Works Consulted

  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.
  • Practice Committee of American Society for Reproductive Medicine (2012). Diagnostic evaluation of the infertile female: An American Society for Reproductive Medicine practice committee opinion. Fertility and Sterility, 98(2): 302–307.
  • Practice Committee of American Society for Reproductive Medicine (2012). Diagnostic evaluation of the infertile male: An American Society for Reproductive Medicine practice committee opinion. Fertility and Sterility, 98(2): 294–301.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Current as of June 4, 2014
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