How Fertility Testing Works: A Guide for Women and Men

Fertility testing is done when people have been struggling to build their family unsuccessfully for a period of six to 12 months. It is a series of tests used as a diagnostic tool by fertility experts to determine what the probable cause of infertility could be. As well, based on the results, doctors can recommend treatments for infertility and family building. Whether one is actively trying to build their family, or planning on doing so in the future, fertility testing helps to diagnose any current or potential issues affecting fertility. So let us look at what to expect during fertility testing.  

Female Fertility Testing

We shall begin with female fertility testing. This involves assessing the ovarian reserve, the appearance of the reproductive system, and checking hormonal levels. 

Blood Tests for Fertility (AMH, FSH, LH, progesterone)

Blood tests for fertility are done to assess female hormones and in particular, estrogen, progesterone, luteinizing hormone (LH), anti-mullerian hormone (AMH) and follicle stimulating hormone (FSH). AMH triggers antral follicle development and is an indicator of how many eggs are remaining in the ovarian reserve.   

FSH is released to help antral follicles grow to maturity, and is released simultaneously with LH  which triggers ovulation, regulates the menstrual cycle and is responsible for progesterone production. Progesterone regulates menstrual cycles together with LH, prepares the endometrium for pregnancy, and supports pregnancy. When progesterone is low, it can lead to preterm labor or miscarriages. 

Ultrasounds and Antral Follicle Count

Ultrasounds are used to examine anomalies in the uterus, fallopian tubes and ovaries. As well, transvaginal ultrasounds are used to determine how many antral follicles are remaining in the ovarian reserve. 

HSG Test for Fallopian Tube Blockages

Fallopian tubes can get blocked due to illness, infection or surgical procedures. A person can still have a menstrual cycle even when their fallopian tubes are blocked. A hysterosalpingogram (HSG) is used to check if a person has blocked fallopian tubes. It is done using an X-ray and contrast liquid which is placed into the uterus using a catheter. If there is blockage, the contrast liquid pools around the area of the blockage.  

Male Fertility Testing

Male reproductive capacity is done through male fertility testing which assesses hormonal levels and the structure of the reproductive organs and sperm. 

Semen Analysis: What It Measures

The most common fertility test for men is a semen or sperm analysis. This test measures the quantity and quality of semen and sperm. This test is done using a fresh sperm sample. In order to acquire one, a doctor will give the patient a sterile cup into which the patient ejaculates in.  The semen volume and viscosity will be measured, as well as its pH and the number of white blood cells in it. As well, the number of sperm, their structure, and how well they move will be assessed.  

Sperm DNA Fragmentation Testing

DNA fragmentation testing assesses whether DNA is damaged or not. If it is damaged, it can cause infertility for men. DNA can get damaged through infection, illness, medical or surgical treatments, or as a result of a medical condition. As well, DNA fragmentation can also be the cause of repeated pregnancy loss where conception takes place. 

Hormonal Testing for Men

Hormonal testing for men assesses testosterone, follicle stimulating hormone (FH), luteinizing hormone (LH) levels, including inhibin. Testosterone regulates primary and secondary sexual characteristics in males, as well as sperm production. FSH helps in the growth of testicles and is vital in developing sperm to maturity. LH stimulates testosterone production while inhibin regulates LH production. 

What to Expect During a Fertility Evaluation

Fertility evaluations will begin with a consultation which evaluates your physical health, medical and sexual history, as well as lifestyle and diet. Women’s menstrual cycle and cycle history will be examined, and men may have their penis, scrotum and testes physically evaluated for anomalies. The time it takes for a fertility evaluation depends on the tests that will be conducted. A basic evaluation may take a few hours, while comprehensive evaluation could take several days. 

Next Steps After Your Test Results

The test results of your fertility evaluation will determine the next steps. Your doctor will walk you through what the results are and what that means with reference to your fertility. Next, they will share some options for treatment based on their assessment, including the side effects and risks involved. At this point you may ask any questions, seek clarification, or raise any concerns on the options given. 

FAQs:

How do I know if I need a fertility test?

There are several reasons to consider going in for a fertility test. For people who have a history of reproductive health conditions, STDs or other pelvic infections, surgeries on the reproductive system, prior chemotherapy, or multiple miscarriages, fertility testing may be helpful if you want to build your family.

What does an AMH test show?

AMH is released in the antral follicles in the ovaries. It shows the quantity of eggs remaining in the ovarian reserve, which indicates the time left before the woman reaches menopause. AMH levels can also give indication into how well a person would respond to fertility treatments, and potentially be used to diagnose PCOS. 

Is male fertility testing painful?

No, a semen analysis is non-invasive and the needle prick for the blood draw may be a bit uncomfortable. If required, testicular biopsies may also result in minor discomfort.   

Can lifestyle changes improve fertility test results?

Positive lifestyle changes such as exercise resulting in a healthy BMI, a balanced diet, rest, stress management, as well as reducing alcohol intake and quitting smoking, all contribute to improved fertility in both men and women.