Those experiencing fertility challenges while trying to build their family may have many questions about fertility. One common question is about fertility testing and the evaluation process. Without the correct information, couples or individuals may delay consulting an infertility specialist for a fertility evaluation. We compiled specific details in this guide to help you make the proper decisions and get started with a fertility evaluation. You will learn more about the fertility evaluation process, what to expect, and the tests involved.
What is Fertility Evaluation?
A fertility evaluation assesses fertility health and involves reviewing medical history, a physical examination, and diagnostic testing. The fertility evaluation process differs for men and women. Through a fertility evaluation, are productive medicine physician can diagnose possible causes of infertility and aid decision-making. After assessing your needs, your fertility physician will recommend the most appropriate treatment plan to reach your family-building goals.
When Do You Need a Fertility Evaluation?
The reasons to seek a fertility evaluation can differ from person to person. The presence and or persistence of these symptoms are typically an indication for a fertility evaluation.
For women, here are some signs you may need a fertility evaluation:
- If you’ve been actively trying to conceive without success for one year (or six months if you’re over 35)
- history of uterine or tubal disease
- irregular periods or no menstrual periods
- history of pelvic inflammatory disease
- history of having had cancer treatment(chemotherapy or radiation treatment, especially if directed to the abdomen andpelvis)
- history of multiple miscarriages
- If you’re 37 or older and want to get pregnant
- history of genetic diseases that run in your families
Here are some indications for fertility evaluation in men:
- a history of testicular trauma
- history of surgery for an undescended testicle or hernia
- treatment with chemotherapy drugs
- history of infertility with a previous partner
- if you’ve been actively trying to conceive without success for one year (6 months if your partner is over age 34)
What to Expect From a Fertility Evaluation?
During your first visit to a fertility clinic, the fertility physician will start with a detailed clinical history to collect your personal health information and identify your unique health needs. The fertility physician may ask you (and your partner) the following:
- history of medical illnesses, including STDs and past pelvic surgery
- medication uses
- sexual history
- duration of infertility
- use of tobacco, alcohol, and illicit drugs
For women, the doctor will typically ask about:
- your last menstrual period
- menstrual cycle length and frequency
- birth control methods
- past pregnancies and their outcomes.
While for men, here are some questions the fertility physicians may ask:
- history of childhood trauma to the testis
- history of infections such as orchitis or mumps
- prior childhood disorders like cryptorchidism
- history of infertility
After the clinical history, your fertility doctor will perform a physical examination.Clinical history details help direct the physician to examine particular organs. For example, males with testicular symptoms may require further urologic examination.
To aid the accuracy of clinical diagnosis, your doctor may recommend a series of diagnostic tests.
What is Fertility Testing?
A fertility specialist uses your medical history obtained when consulting with you to help choose the most suitable diagnostic tests that fit your personal situation. Hence, consulting with a fertility specialist early in the process may save you time and money and keep you from having any unnecessary testing.
Fertility testing involves a combination of laboratory tests and imaging studies to try to identify an explanation for your struggles to conceive. The results of these tests often point to a cause of your infertility, though it is important to know that at least 20% of the time, there is no explanation identified becauseall of the tests come back normal. The testing results will help your fertility provider know what treatments are available to you and will also help them know what treatment they would recommend as the most appropriate.
Fertility testing procedures are obviously different for men and women and best requested by fertility physicians.
Fertility Testing for Women
Female fertility testing entails using specific tests and radiological procedures to assess the ovarian function of your fallopian tubes and the integrity of the uterine cavity. Here are specific tests often performed in a complete fertility evaluation:
Assessment of Ovarian Function and Reserve
Ovulation— the release of a mature egg from the ovaries occurs at a specific time point in the monthly menstrual cycle. Ovulation testing helps to determine if a female is ovulating or not. It involves hormone testing on specific days in the menstrual cycle.
Ovarian reserve testing— women, lose the ability to get pregnant as they get older due to a decline in their ovaries and egg quality. Testing of your ovarian reserve is performed using a combination of blood testing of reproductive hormones and ultrasounds assessing what is referred to as your follicle count.
Follicles are fluid sacs with an egg, which are visible on ultrasound early in your cycle. The number of follicles you have represents the number of eggs available to your body for ovulation that month. Typically, women start with a relatively large number of follicles, even if they ovulate only one egg at a time.
Hormone testing is another important part of evaluating ovarian function. These blood tests assess the level of hormones such as follicle stimulating hormones( FSH), antimullerian hormone (AMH), and estrogen levels in the blood.
Most of these ultrasounds and hormonal blood tests must be performed on a particular day of your menstrual cycle. AMH testing, however, can be done at any time in the menstrual cycle.Your fertility physician interprets the results from these hormone tests and determines if the ovarian function and reserve are within normal range.
Assessment of the Uterine Cavity
There are different methods for assessing the uterus. Typically, fertility experts use imaging tools to inspect the uterine cavity for abnormalities such as congenital uterine defects and adhesions. In addition, fertility doctors typically use a hysteroscope (a long lighted, flexible tube) to visualize the interior layers of the uterus. The procedure is called hysteroscopy.
There is also a specialized ultrasound that is performed at the same time saline is instilled into your uterus to better determine if there is anything abnormal that may be keeping you from getting pregnant.This is known as a saline sonohysterogram. Your physician will determine which of these tests is/are most appropriate.
Assessment of the Fallopian Tubes
Fallopian tubes are typically assessed in the clinic with a procedure known as a hysterosalpingogram or HSG. This fertility test aims to inspect the fallopian tubes for occlusions or blockages.The fallopian tubes can become blocked due to prior pelvic infections, endometriosis, or prior pelvic surgeries.
An HSG involves using X-rays and X-ray contrast to outline the fallopian tubes and uterus. This test is typically done in the week or so after your period ends but before ovulation occurs so that there is no chance you are pregnant when you have it performed.
Laparoscopy (an actual surgery) is another method your fertility physician may decide to use to assess the fallopian tubes. However, it is invasive and not often the first choice.
Fertility Testing for Men
Semen analysis is the primary method of male fertility testing. The andrologist analyzes the semen for various characteristics such as the quality and quantity of sperm cells. Before the test, you or your partner will be counseled to abstain from sexual activity for 2-5 days. Your fertility doctor interprets the semen analysis result to determine the impact.
Here are the specific components of a semen analysis test.
What most people refer to as a “sperm count” is technically a measure of the concentration of sperm in the ejaculate. It is reported as the sample's number of sperm cells per milliliter. According to the World Health Organization (WHO), the normal sperm cell count should beat least 15 million cells per milliliter. If the sperm cell count is below this level, the fertility doctor will typically assess the possible causes and recommend the most suitable therapeutic intervention.
Sperm motility evaluates the movement pattern of sperm cells in the ejaculated semen.A sperm sample should have at least 40% progressive sperm motility, which does mean that it can be normal if over half of the sperm in the sample is “dead.”
Unlike conventional laboratory evaluation of sperm motility, computer-assisted semen analysis (CASA) uses digital technology to provide an in-depth kinetic analysis of sperm cells. CASA provides details on the sperm head motion patterns and a quantitative overview of the sperm cell kinetics.
The word morphology means the shape, and so when your sperm is assessed as part of the analysis, we take a look to see what percentage of your sperm looks normal in every respect. Here the concept is that it is only normally shaped sperm that are capable of fertilizing an egg.
Any defects or abnormalities in the sperm head, neck, body, or tail typically affect sperm quality and increase the risk of male infertility. A normal semen analysis should have at least 4% sperm cells with a normal shape.
Other features assessed in a semen analysis include:
- pH:Normal range is 7.0-8.0
- Volume:Normal should be at least 2 mls per ejaculated semen
- White blood cells: White blood cells are typically absent in semen. The presence of white cells indicates an infection.
- Sperm viability: Some of the sperm ejaculated are simply dead. The viability assay helps determine if there is too high of a percentage of sperm that are dead when ejaculated.
Do You Need a Fertility Evaluation?
Fertility evaluation involves a review of your medical history, a physical examination, and specialized diagnostic tests. This process helps a fertility physician to evaluate your fertility status and offer solutions to any fertility problems.
Getting a fertility evaluation starts with consulting a fertility expert and choosing a fertility clinic with a team of professional fertility experts with a proven track record of helping couples or individuals start and expand their families. The proper fertility evaluation is essential to move you towards achieving your dream of starting or growing your family.
The first step in your fertility journey to parenthood is an initial consultation with one of our fertility specialists at Advanced Fertility Care. We have dedicated fertility professionals who assess our patients using the most recent reproductive technology solutions. We provide personalized fertility evaluations and testing that fits your unique health needs. Schedule your initial consultation today to get started on realizing your dreams of parenthood.