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.

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.

  • 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.

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.

  • Thyroid function tests may
    be done to check for thyroid hormone problems that may be preventing ovulation.

  • Prolactin is a
    hormone made by the pituitary gland. It may be checked
    if a woman has menstrual cycle or ovulation problems.

  • 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.

  • 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.

  • 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.

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.

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).

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.

Sonohysterogram

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

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.

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.

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.

  • Genetic tests may be done
    to help find the cause of infertility.

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.

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.

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.

Health Tools

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Other Places To Get Help

Organization

American Society for Reproductive
Medicine
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

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC – Obstetrics and Gynecology

Current as ofMarch 16, 2017